title: A Study on Dosimetric Outcomes and Acute Toxicity of Post Mastectomy Adjuvant Hypofractionated Radiotherapy for Breast Cancer.
abstract: BACKGROUND
  Hypofractionated External Beam Radiotherapy (HFRT) is a relatively new adjuvant Radiotherapy (RT) schedule for breast cancers following breast conservation surgery and less commonly, following mastectomy. Here we report our experience on normal tissue exposure and acute toxicity of HFRT after mastectomy.
  
  
  OBJECTIVE
  To assess the dosimetric outcomes and acute toxicity profile of adjuvant HFRT following mastectomy for breast cancer.
  
  
  METHODS
  This prospective observational study considered consecutive patients planned for adjuvant HFRT (42.5 Gy in 16 sessions delivered over 3 weeks) to the chest wall with/without regional nodes between October 2014 and June 2015. The dosimetric parameters including dose homogeneity to the target volume and exposure to heart and lung were analyzed. Acute haematological and dermatological toxicity was recorded until upto three months after completion of RT.
  
  
  RESULTS
  Among the 56 patients treated with HFRT, the mean age was 49 years (range: 28-69 years). Pathologically positive nodes and ≥pT3 primary was observed in 44 (78.6%) and 12 (21.4%) patients, respectively. Majority (87.5%) received prior adjunct chemotherapy. RT to the supraclavicular fossa was delivered for 39 (69.6%) patients. The mean V90 and V95 to the Planning Target Volume (PTV) were 95% (± 3.3%) and 93% (± 4%), respectively. The maximum dose received was on average 47.7 Gy (112%; range: 46.2-48.5 Gy). The mean lung dose was 10.2 Gy (± 3.5 Gy) and V20 was 20.9% (± 6%). The mean V25 to heart was 6.6% (± 4.8%) for left sided and 0% for right sided tumours (p=0.001). Acute skin toxicity peaked at completion of RT and was tolerable (grade 0, I, II and III reactions were 75%, 16% and 1.8%, respectively). No patient had ≥ grade III haematological toxicity, and treatment was not interrupted for any patient.
  
  
  CONCLUSIONS
  Adjuvant HFRT could be planned while meeting the dose constraints to normal tissues in all patients and was well tolerated, with mild to moderate acute adverse effects that did not warrant any therapeutic intervention or treatment interruption.
authors.affiliation: Resident, Department of Radiotherapy, Kasturba Medical College , Manipal, Karnataka, India .
authors.forename: Shivaprasad
authors.initials: S
authors.lastname: Deshmukh
authors.affiliation: Associate Professor, Departmentof Radiotherapy, Kasturba Medical College , Manipal, Karnataka, India .
authors.forename: Krishna
authors.initials: K
authors.lastname: Sharan
authors.affiliation: Professor and Head, Department of Radiotherapy, Kasturba Medical College , Manipal, Karnataka, India .
authors.forename: Donald Jerard
authors.initials: DJ
authors.lastname: Fernandes
authors.affiliation: Professor, Department of Radiotherapy, Kasturba Medical College , Manipal, Karnataka, India .
authors.forename: Vidyasagar Mamidipudi
authors.initials: VM
authors.lastname: Srinivasa
authors.affiliation: Assistant Professor, Department of Radiotherapy, Kasturba Medical College , Manipal, Karnataka, India .
authors.forename: Prahlad Hiremagalur
authors.initials: PH
authors.lastname: Yathiraj
authors.affiliation: Assistant Professor, Department of Radiotherapy, Kasturba Medical College , Manipal, Karnataka, India .
authors.forename: Anshul
authors.initials: A
authors.lastname: Singh
authors.affiliation: Senior Resident, Department of Radiotherapy, Kasturba Medical College , Manipal, Karnataka, India .
authors.forename: Anusha
authors.initials: A
authors.lastname: Reddy
keywords: Adjuvant radiotherapy; Haematological toxicity; Hypofractionation; Radiation dermatitis; Radiation pneumonitis