title: Hypofractionated Breast Radiation: Shorter Scheme, Lower Toxicity.
abstract: We analyzed the toxicity and cosmetic outcomes for patients who had undergone 3-dimensional conformal radiotherapy with a hypofractionated schedule and identified the risk factors associated with such a schedule.
  
  
  
  A total of 143 patients were treated for breast cancer (stage 0-III) with a hypofractionated radiation schedule after breast-conserving surgery from 2006 to 2011. Most patients received 42.4 Gy in 16 daily fractions, 2.65 Gy per fraction to the whole breast plus an additional simultaneous integrated or sequential boost to the tumor bed.
  
  
  
  The median follow-up period was 36 months. Mild acute skin toxicity was observed in 62%; 7% of the patients developed moderate skin toxicity, but no grade 4 toxicity was observed. The prevalence of fibrosis within the boost area was 5%, but no grade ≥ 2 was observed. The prevalence of fibrosis of any grade was greater in the nonboost (23%) than in the boost area. Of all the patients, 91% had good or excellent cosmetic outcomes. From the multivariate analysis, the incidence of epithelitis correlated with the patient's treated volume (P = .044). The incidence of acute toxicity correlated with the boost type to the tumor bed and the total treatment dose (P = .012 and P = .002, respectively). Also, a poor to fair cosmetic outcome was significantly associated statistically with the surgery type (P = .05), boost type (P = .004), and total dose (P = .001).
  
  
  
  Delivering whole-breast irradiation with a hypofractionated schedule of 42.4 Gy plus a simultaneous integrated boost to the tumor bed appears to be a safe and effective technique, with good cosmetic results and lower toxicity.
authors.affiliation: Department of Radiotherapy and Oncology, Virgen de las Nieves University Hospital, Granada, Spain. Electronic address: ilg686@hotmail.com.
authors.forename: Isabel
authors.initials: I
authors.lastname: Linares
authors.affiliation: Department of Radiotherapy and Oncology, Virgen de las Nieves University Hospital, Granada, Spain.
authors.forename: María Isabel
authors.initials: MI
authors.lastname: Tovar
authors.affiliation: Department of Radiotherapy and Oncology, Virgen de las Nieves University Hospital, Granada, Spain.
authors.forename: Mercedes
authors.initials: M
authors.lastname: Zurita
authors.affiliation: Department of Radiotherapy and Oncology, Virgen de las Nieves University Hospital, Granada, Spain.
authors.forename: Rosario
authors.initials: R
authors.lastname: Guerrero
authors.affiliation: Institute of Biosanitaria ibs, Virgen de las Nieves University Hospital, Granada, Spain.
authors.forename: Manuela
authors.initials: M
authors.lastname: Expósito
authors.affiliation: Department of Radiotherapy and Oncology, Virgen de las Nieves University Hospital, Granada, Spain.
authors.forename: Rosario
authors.initials: R
authors.lastname: Del Moral
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D005240:Feasibility Studies; D005260:Female; D005355:Fibrosis; D005500:Follow-Up Studies; D006801:Humans; D015412:Mastectomy, Segmental; D008875:Middle Aged; D009367:Neoplasm Staging; D015995:Prevalence; D000069473:Radiation Dose Hypofractionation; D011832:Radiation Injuries / Q000453:epidemiology*; D018714:Radiotherapy, Adjuvant / Q000379:methods*; D020266:Radiotherapy, Conformal / Q000379:methods; D012307:Risk Factors; D012867:Skin / Q000473:pathology / Q000528:radiation effects*; D016896:Treatment Outcome
keywords: Breast cancer; Cosmesis; Radiotherapy; Regional nodal irradiation; Simultaneous integrated boost