Benjamin D Smith1, Jennifer R Bellon2, Rachel Blitzblau3, Gary Freedman4, Bruce Haffty5, Carol Hahn6, Francine Halberg7, Karen Hoffman8, Kathleen Horst9, Jean Moran10, Caroline Patton11, Jane Perlmutter12, Laura Warren2, Timothy Whelan13, Jean L Wright14, Reshma Jagsi10. 1. Department of Radiation Oncology, MD Anderson Cancer Center, Houston, Texas. Electronic address: bsmith3@mdanderson.org. 2. Department of Radiation Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts. 3. Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina. 4. Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania. 5. Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey. 6. Department of Radiation Oncology, Duke Cancer Center Wake County, Raleigh, North Carolina. 7. Department of Radiation Oncology, Marin Cancer Institute, Greenbrae, California. 8. Department of Radiation Oncology, MD Anderson Cancer Center, Houston, Texas. 9. Department of Radiation Oncology, Stanford University, Stanford, California. 10. Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan. 11. American Society for Radiation Oncology, Arlington, Virginia. 12. Patient Representative, Ann Arbor, Michigan. 13. Department of Oncology, McMaster University, Hamilton, Ontario, Canada. 14. Department of Radiation Oncology, Johns Hopkins University, Baltimore, Maryland.
Abstract
INTRODUCTION: The purpose of this guideline is to offer recommendations on fractionation for whole breast irradiation (WBI) with or without a tumor bed boost and guidance on treatment planning and delivery. METHODS AND MATERIALS: The American Society for Radiation Oncology (ASTRO) convened a task force to address 5 key questions focused on dose-fractionation for WBI, indications and dose-fractionation for tumor bed boost, and treatment planning techniques for WBI and tumor bed boost. Guideline recommendations were based on a systematic literature review and created using a predefined consensus-building methodology supported by ASTRO-approved tools for grading evidence quality and recommendation strength. RESULTS: For women with invasive breast cancer receiving WBI with or without inclusion of the low axilla, the preferred dose-fractionation scheme is hypofractionated WBI to a dose of 4000 cGy in 15 fractions or 4250 cGy in 16 fractions. The guideline discusses factors that might or should affect fractionation decisions. Use of boost should be based on shared decision-making that considers patient, tumor, and treatment factors, and the task force delineates specific subgroups in which it recommends or suggests use or omission of boost, along with dose recommendations. When planning, the volume of breast tissue receiving >105% of the prescription dose should be minimized and the tumor bed contoured with a goal of coverage with at least 95% of the prescription dose. Dose to the heart, contralateral breast, lung, and other normal tissues should be minimized. CONCLUSIONS: WBI represents a significant portion of radiation oncology practice, and these recommendations are intended to offer the groundwork for defining evidence-based practice for this common and important modality. This guideline also seeks to promote appropriately individualized, shared decision-making regarding WBI between physicians and patients.
INTRODUCTION: The purpose of this guideline is to offer recommendations on fractionation for whole breast irradiation (WBI) with or without a tumor bed boost and guidance on treatment planning and delivery. METHODS AND MATERIALS: The American Society for Radiation Oncology (ASTRO) convened a task force to address 5 key questions focused on dose-fractionation for WBI, indications and dose-fractionation for tumor bed boost, and treatment planning techniques for WBI and tumor bed boost. Guideline recommendations were based on a systematic literature review and created using a predefined consensus-building methodology supported by ASTRO-approved tools for grading evidence quality and recommendation strength. RESULTS: For women with invasive breast cancer receiving WBI with or without inclusion of the low axilla, the preferred dose-fractionation scheme is hypofractionated WBI to a dose of 4000 cGy in 15 fractions or 4250 cGy in 16 fractions. The guideline discusses factors that might or should affect fractionation decisions. Use of boost should be based on shared decision-making that considers patient, tumor, and treatment factors, and the task force delineates specific subgroups in which it recommends or suggests use or omission of boost, along with dose recommendations. When planning, the volume of breast tissue receiving >105% of the prescription dose should be minimized and the tumor bed contoured with a goal of coverage with at least 95% of the prescription dose. Dose to the heart, contralateral breast, lung, and other normal tissues should be minimized. CONCLUSIONS: WBI represents a significant portion of radiation oncology practice, and these recommendations are intended to offer the groundwork for defining evidence-based practice for this common and important modality. This guideline also seeks to promote appropriately individualized, shared decision-making regarding WBI between physicians and patients.
Authors: Icro Meattini; Marta Scorsetti; Fiorenza De Rose; Maria Carmen De Santis; Bruno Meduri; Ciro Franzese; Davide Franceschini; Pierfrancesco Franco; Nadia Pasinetti; Valentina Lancellotta; Patrizia Giacobazzi; Eliana La Rocca; Elisa D'Angelo; Laura Lozza; Lorenzo Livi Journal: J Cancer Res Clin Oncol Date: 2021-01-02 Impact factor: 4.553
Authors: Audree B Tadros; Tracy-Ann Moo; Emily C Zabor; Erin F Gillespie; Atif Khan; Beryl McCormick; Oren Cahlon; Simon N Powell; Robert Allen; Monica Morrow; Lior Z Braunstein Journal: Pract Radiat Oncol Date: 2020-03-20
Authors: Ravi B Parikh; Ezra Fishman; Winnie Chi; Robert P Zimmerman; Atul Gupta; John J Barron; Gosia Sylwestrzak; Justin E Bekelman Journal: JAMA Oncol Date: 2020-06-01 Impact factor: 31.777