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William J. Gradishar, MD, FACP, FASCO


ASTRO 2023: Is Preoperative Radiation Boost of Benefit in Treating Breast Cancer?

By: Chris Schimpf, BS
Posted: Wednesday, October 11, 2023

A radiation boost prior to lumpectomy followed by whole-breast irradiation may be an effective course of treatment for patients with breast cancer, allowing for more accurate targeting of the tumor and sparing more normal breast tissue than the standard-of-care, postoperative whole-breast irradiation and radiation boost procedures. Zeinab Abou Yehia, MD, of Rutgers Cancer Institute of New Jersey, New Brunswick, and colleagues presented the first results of their phase II prospective clinical trial at the 2023 American Society for Radiology Oncology (ASTRO) Annual Meeting (Abstract 1114); the incidence of grade 3 or greater wound complications was not found to be inferior to the current standard of care. The researchers are currently planning an expanded study to assess longer-term cosmetic outcomes and immune response to the preoperative radiation boost.

A total of 48 women (median age, 64 years) with nonmetastatic, node-negative breast cancer or ductal carcinoma in situ who were eligible for breast-conserving therapy were included in the study. Among the participants, 43 (90%) had invasive cancers, and 5 (10 %) had ductal carcinoma in situ. The investigators reported a median clinical tumor size of 13 mm (range, 5–26 mm), a median pathologic tumor size of 9 mm (range, 0–27 mm), and negative margins in 47 patients (98%).

The participants were treated with a preoperative radiation boost of 1,332 cGy in four fractions, followed by lumpectomy and adjuvant hypofractionated whole-breast radiation to 3,663 cGy in 11 fractions. Within the 2-month median follow-up period, grade 3 wound dehiscence requiring surgical revision occurred in one patient (2%), and three patients (6%) reported grade 2 wound infections requiring antibiotics. The investigators indicated that at first follow-up, the cosmetic outcome was very good or excellent in 39 patients (87%) and that no patient had a poor cosmetic outcome.

Disclosure: Dr. Abou Yehia reported no conflicts of interest.

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