Implementation of 26 Gy in five fractions over 1 week adjuvant radiotherapy for 
breast cancer: Prospective report of acute skin toxicity and consideration of 
resource implications

Nugent, K.; Quinlan, E.; Cleary, S.; O'Driscoll, H.; Rohan, C.; Trousdell, J.; Williams, J.; Dunne, M.; McArdle, O.; Duane, F. K.

doi:10.1016/j.breast.2022.12.008

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Journal Article

Implementation of 26 Gy in five fractions over 1 week adjuvant radiotherapy for breast cancer: Prospective report of acute skin toxicity and consideration of resource implications

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Williams, J.
Atmospheric Chemistry, Max Planck Institute for Chemistry, Max Planck Society;

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https://www.sciencedirect.com/science/article/pii/S0960977622002077/pdfft?md5=b446acd65d3d3cfd120b600e460de7ab&pid=1-s2.0-S0960977622002077-main.pdf
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Citation

Nugent, K., Quinlan, E., Cleary, S., O'Driscoll, H., Rohan, C., Trousdell, J., et al. (2023). Implementation of 26 Gy in five fractions over 1 week adjuvant radiotherapy for breast cancer: Prospective report of acute skin toxicity and consideration of resource implications. Breast, 67: 1104582, pp. 55-61. doi:10.1016/j.breast.2022.12.008.

Cite as: https://hdl.handle.net/21.11116/0000-000D-411D-A

Abstract

Purpose

In March 2020, a 1-week adjuvant breast radiotherapy schedule, 26 Gy in 5 fractions, was adopted to reduce the risk of COVID19 for staff and patients. This study quantifies acute toxicity rates and the effect on linac capacity.
Materials and methods

This is a report of consecutive patients receiving ultrafractionated breast radiotherapy ( ± sequential boost) Mar–Aug 2020. Virtual consultations assessed acute skin toxicity during treatment and weeks 1, 2, 3 and 4 post treatment using CTCAE V5 scoring criteria. The number of linac minutes saved was estimated accounting for boost and DIBH use.
Results

In total, 128/135 (95%) patients, including 31/33 boost patients, completed at least 3/5 assessments. 0/128 (0%) reported moist desquamation not confined to skin folds or minor bleeding (Grade 3), 41/128 (32%) reported brisk erythema, moist desquamation confined to skin folds or breast swelling (Grade 2), 62/128 (48%) reported faint erythema or dry desquamation (Grade 1) as their worst skin toxicity, with the remaining 20% reporting no skin toxicity. The highest prevalence of grade 2 toxicity occurred week 1 following treatment (20%), reducing to 3% by week 4. There was no difference in toxicity between those who received a boost versus not (p = 1.00). Delivering this schedule to 135 patients over six months saved 21,300 linac minutes and 1485 hospital visits compared to a 3-week schedule.
Conclusion

Rapidly implementing ultrahypofractionated breast radiotherapy is feasible and acute toxicity rates are acceptable even when followed by boost.