Feasibility and Safety of the u201cOne-Week Breast Radiation Therapyu201d Program

• Published in: Clinical oncology (Royal College of Radiologists (Great Britain)) Vol. 36; no. 9; pp. e333 - e341
• Main Authors: Ba, M. B., Bellini, C., Auzac, G., Louvel, G., Bockel, S., Moukasse, Y., Chaffai, I., Berthelot, K., Vatonne, A., Deutsch, E., Milewski, C., Rivera, S., Giudici, F., Larue, C., Michiels, S., Conversano, A., Viansone, A.
• Format: Journal Article
• Language: English
• Published: WB Saunders 2024
• Subjects: Life Sciences; Acute toxicities; early breast cancer; hypofractionated radiation therapy; intensity modulated radiation therapy; prospective cohort; real life data
• DOI: 10.1016/j.clon.2024.06.045
• ISSN: 0936-6555

© 2024 The Royal College of RadiologistsAims: FAST-Forward and UK-FAST-trials have demonstrated the safety and efficacy of five-fraction breast adjuvant radiation therapy (RT) and have become the standard of care for selected early breast cancer patients. In response to the additional burden caused by the COVID-19 pandemic, we implemented u201cOne-Week Breast RT,u201d an innovative program delivering five-fraction whole breast RT in a complete 5-day workflow. The primary objective of this study was to demonstrate the feasibility and safety of our program. The secondary objective was to evaluate cosmetic results. Material and methods: A total of 120 patients treated from February 2021 to March 2022, received whole breast RT without lymph node irradiation nor boost, with 26 Gy in five fractions over one week. Inverse planning with restricted optimization parameters offers systematic deep inspiration breath-hold aimed to provide treatment plans compliant with FAST-Forward recommendations. Toxicity and cosmetic evaluations were prospectively registered prior (pre-RT), at the end (end-RT), and 6 months after RT (6 months) based on Common Terminology Criteria for Adverse Events v. 4.03 and Harvard scale. Results: With a median age of 70 years (interquartile range (IQR): 66u201374) and a median follow-up of 6 months (IQR: 6.01u20136.25), most patients (93.3%) completed their RT in one week from baseline to the end of the treatment consultation. The most common acute toxicities (at end-RT) were skin-related: radio-dermatitis (72%), induration (35%), hyperpigmentation (8%), and breast edema (16%). The rate of radio-dermatitis decreased from end-RT to 6 months (71.7% vs 5.4%, P< 0.001). No patient experienced grade ≥3 toxicity. At 6 months, cosmetic results were generally good or excellent (94.1%). Conclusion: This study confirms the feasibility and acute safety of the u201cOne-Week Breast RTu201d in real life. Favorable toxicity profiles and good cosmetic outcomes are in line with FAST-Forward results. A prospective national cohort, aimed at decreasing treatment burden, maintaining safety, efficacy, and improving RT workflow efficiency with longer follow-up is ongoing.