Toxicity and cosmetic outcome in hypofractionated radiation therapy for ductal carcinoma in situ after breast-conserving surgery: a preliminary report

Abstract

Background : Hypofractionation radiotherapy (HFx) following breast - conserving surgery (BCS) in ductal carcinoma in situ (DCIS) has been shown to be safe in many retrospective studies. In this paper, we report our data and assess those outcomes to support the use of HFx in DCIS. Material and Methods : All patients with DCIS after BCS were treated with 4250cGy in 16 fractions to whole breast with tumor bed boost 1000cGy in 4 fractions. The toxicity was evaluated using CTCAE v.5.0. On the last day of radiation (day 0) then 1 and 6 months post radiation. The cosmesis was evaluated at 6 months. Results : Between July 2018 and December 2019 at our center, 33 patients were analyzed with a median follow up of 7.3 months. No toxicity of more than grade2 occurred. At day 0 and 1 month after radiation, 89% and 85% of patients had grade1 dermatitis and hyperpigmentation, respectively. For induration, 33% had grade1 at day 0, 29% at 1 month, and 44.8% at 6 months. Only 3% had grade2 induration at 1 month. In addition, 67% of the subjects had grade1 pruritus and 37% had grade1 pain at day0. Radiation oncologists assessed good - to - excellent cosmesis in 93% of these patients, while the 96.6% of patients self - evaluated as good to excellent without impact on their self - confidence. Conclusion : This prospective trial showed that HFx can be safely used in DCIS with no more than grade2 skin toxicity and good to excellent cosmesis.