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Top Line: Breast radiation is the next radiation that needs a thoughtful pandemic remix.
The Study: First of all, when it comes to breast cancer, we fortunately don’t have to fly by the seat of our pants. The breast team from MSKCC have compiled evidence-based recs for lowering your on-treatment volume of breast radiation. It hinges on the now-familiar RADS framework—they were just missing the British collaboration so weren’t quite as quippy. Perhaps the most common sense strategy is avoiding radiation for women who can safely do so with no increased risk of death or even mastectomy (i.e. good-risk DCIS and favorable ER(+) invasive cancers in women over 65). In terms of delaying, evidence indicates starting up to 12-20 weeks out from surgery and / or chemo for DCIS and early-stage disease portends no worsening of outcomes. Now, the meat of the matter comes with the myriad evidence-based options for extreme hypofractionation (thank you, Table 1). The short of it (see what we did there) is that partial and even whole breast courses need not span more than 5 treatments, and post-mastectomy and regional nodal treatments needn’t exceed 15-16. Finally, Table 2 provides an excellent summary of how patient treatments should be prioritized in the unfortunate case of severe staff shortages.
TBL: Rethink how you will approach breast cancer cases in the coming weeks to months. | Braunstein, Adv Radiat Oncol 2020