If it ain’t broke…
Top Line: Five-fraction accelerated partial breast irradiation (APBI) and 5-fraction whole breast radiation are increasingly used for early stage breast cancer. So, what if we just did it pre-op?
The Study: This Belgian study tested the feasibility of 5-fraction pre-op radiation in 14 women with cT1-T2 N0, grade 1-2, luminal A or B breast cancer. All patients were staged with MRI. They used a simultaneous integrated boost technique to treat the whole breast and lumpectomy cavity boost all in 5 fractions. The boost CTV was a 1 cm expansion from the GTV, and the boost PTV was an additional 5 mm expansion. The whole breast was prescribed 25 Gy and the boost was prescribed 30 Gy. Treatment was delivered on 5 consecutive days, and breast conservation surgery and sentinel node biopsy was performed 2-8 days after the completion of radiation. Over a third of patients (35.7%) experienced wound complications including two cases of mastitis requiring antibiotics, two cases of fistula requiring antibiotics, and one fistula requiring reoperation. Two patients (14%) had positive sentinel lymph nodes requiring axillary dissection. Ultimately, preoperative accelerated breast radiation seemed to further complicate an already effective treatment paradigm.
TBL: While preoperative 5-fraction whole breast radiation with a SIB was feasible, over a third of patients had wound complications and the use of preoperative radiation further complicated treatment for a subset of lymph node positive patients. | Mulliez, Radiother Oncol 2022