title: Early-stage breast cancer treated with 3-week accelerated whole-breast radiation therapy and concomitant boost.
abstract: OBJECTIVE
  To report early outcomes of accelerated whole-breast radiation therapy with concomitant boost.
  
  
  METHODS
  This is a prospective, institutional review board-approved study. Eligibility included stage TisN0, T1N0, and T2N0 breast cancer. Patients receiving adjuvant chemotherapy were ineligible. The whole breast received 40.5 Gy in 2.7-Gy fractions with a concomitant lumpectomy boost of 4.5 Gy in 0.3-Gy fractions. Total dose to the lumpectomy site was 45 Gy in 15 fractions over 19 days.
  
  
  RESULTS
  Between October 2004 and December 2010, 160 patients were treated; stage distribution was as follows: TisN0, n = 63; T1N0, n = 88; and T2N0, n = 9. With a median follow-up of 3.5 years (range, 1.5-7.8 years) the 5-year overall survival and disease-free survival rates were 90% (95% confidence interval [CI] 0.84-0.94) and 97% (95% CI 0.93-0.99), respectively. Five-year local relapse-free survival was 99% (95% CI 0.96-0.99). Acute National Cancer Institute/Common Toxicity Criteria grade 1 and 2 skin toxicity was observed in 70% and 5%, respectively. Among the patients with ≥ 2-year follow-up no toxicity higher than grade 2 on the Late Effects in Normal Tissues-Subjective, Objective, Management, and Analytic scale was observed. Review of the radiation therapy dose-volume histogram noted that ≥ 95% of the prescribed dose encompassed the lumpectomy target volume in >95% of plans. The median dose received by the heart D05 was 215 cGy, and median lung V20 was 7.6%.
  
  
  CONCLUSIONS
  The prescribed accelerated schedule of whole-breast radiation therapy with concomitant boost can be administered, achieving acceptable dose distribution. With follow-up to date, the results are encouraging and suggest minimal side effects and excellent local control.
authors.affiliation: Department of Radiation Oncology, Beth Israel Medical Center, New York, New York 10003, USA. MChadha@chpnet.org
authors.forename: Manjeet
authors.initials: M
authors.lastname: Chadha
authors.forename: Rudolph
authors.initials: R
authors.lastname: Woode
authors.forename: Jussi
authors.initials: J
authors.lastname: Sillanpaa
authors.forename: David
authors.initials: D
authors.lastname: Lucido
authors.forename: Susan K
authors.initials: SK
authors.lastname: Boolbol
authors.forename: Laurie
authors.initials: L
authors.lastname: Kirstein
authors.forename: Michael P
authors.initials: MP
authors.lastname: Osborne
authors.forename: Sheldon
authors.initials: S
authors.lastname: Feldman
authors.forename: Louis B
authors.initials: LB
authors.lastname: Harrison
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D002278:Carcinoma in Situ / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D018270:Carcinoma, Ductal, Breast / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D018572:Disease-Free Survival; D019583:Dose Fractionation, Radiation; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D015412:Mastectomy, Segmental; D008875:Middle Aged; D009367:Neoplasm Staging; D011446:Prospective Studies; D012867:Skin / Q000528:radiation effects