title: Highly Accelerated Irradiation in 5 Fractions (HAI-5): Feasibility in Elderly Women With Early or Locally Advanced Breast Cancer.
abstract: To investigate, in a prospective phase 1 to 2 trial, the safety and feasibility of delivering external beam radiation therapy in 5 fractions to the breast or thoracic wall, including boost and/or lymph nodes if needed, to women aged ≥65 years with breast cancer.
  
  
  
  Ninety-five patients aged ≥65 years, referred for adjuvant radiation therapy, were treated in 5 fractions over 12 days with a total dose of 28.5 Gy/5.7 Gy to the breast or thoracic wall and, if indicated, 27 Gy/5.4 Gy to the lymph node regions and 32.5 Gy/6.5 Gy to 34.5 Gy/6.9 Gy to the tumor bed. The primary endpoint was clinically relevant dermatitis (grade ≥2).
  
  
  
  Mean follow-up time was 5.6 months, and mean age was 73.6 years. Clinically relevant dermatitis was observed in 11.6% of patients and only occurred in breast irradiation with boost (17.5% grade 2-3 vs 0% in the no-boost group). Although doses were high, treatment delivery with intensity modulated radiation therapy was swift, except for complex treatments, including lymph nodes for which single-arc volumetric modulated arc therapy was needed to reduce beam-on time.
  
  
  
  Accelerated radiation therapy in 5 fractions was technically feasible and resulted in low acute toxicity. Clinically relevant erythema was only observed in patients receiving a boost, but still at an acceptable rate. Although the follow-up is still short, the results on acute toxicity after accelerated radiation therapy were encouraging. A 5-fraction schedule is well tolerated in the elderly and may lower the threshold for radiation therapy in this population.
authors.affiliation: Department of Radiation Oncology, Ghent University Hospital, Ghent, Belgium. Electronic address: chris.monten@uzgent.be.
authors.forename: Chris
authors.initials: C
authors.lastname: Monten
authors.affiliation: Department of Radiation Oncology, Ghent University Hospital, Ghent, Belgium.
authors.forename: Yolande
authors.initials: Y
authors.lastname: Lievens
authors.affiliation: Department of Radiation Oncology, Ghent University Hospital, Ghent, Belgium.
authors.forename: Luiza Ana Maria
authors.initials: LAM
authors.lastname: Olteanu
authors.affiliation: Department of Radiation Oncology, Ghent University Hospital, Ghent, Belgium.
authors.forename: Leen
authors.initials: L
authors.lastname: Paelinck
authors.affiliation: Department of Radiation Oncology, Ghent University Hospital, Ghent, Belgium.
authors.forename: Bruno
authors.initials: B
authors.lastname: Speleers
authors.affiliation: Department of Radiation Oncology, Ghent University Hospital, Ghent, Belgium.
authors.forename: Pieter
authors.initials: P
authors.lastname: Deseyne
authors.affiliation: Department of Obstetrics and Gynaecology, Ghent University Hospital, Ghent, Belgium.
authors.forename: Rudy
authors.initials: R
authors.lastname: Van Den Broecke
authors.affiliation: Department of Radiation Oncology, Ghent University Hospital, Ghent, Belgium.
authors.forename: Wilfried
authors.initials: W
authors.lastname: De Neve
authors.affiliation: Department of Radiation Oncology, Ghent University Hospital, Ghent, Belgium.
authors.forename: Liv
authors.initials: L
authors.lastname: Veldeman
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology* / Q000532:radiotherapy*; D019583:Dose Fractionation, Radiation; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015182:Lymphatic Irradiation / Q000009:adverse effects / Q000379:methods; D008408:Mastectomy; D011446:Prospective Studies; D011855:Radiodermatitis / Q000209:etiology / Q000473:pathology; D018714:Radiotherapy, Adjuvant / Q000009:adverse effects / Q000379:methods; D050397:Radiotherapy, Intensity-Modulated / Q000009:adverse effects / Q000379:methods*; D013997:Time Factors; D014057:Tomography, X-Ray Computed