Real World Safety of Adjuvant Ultra Hypofractionated Radiotherapy in Nonmetastatic Breast Cancer: Acute Cutaneous Toxicity and Aesthetic Outcomes.

BACKGROUND

Ultra-hypofractionated radiotherapy (U-HFRT) delivers a total dose in five fractions over one week and represents an emerging approach in the adjuvant treatment of breast cancer. However, concerns about toxicity continue to limit its widespread adoption in routine clinical practice. Skin toxicity, one of the most common side effects of breast RT, can significantly affect patients' quality of life and may lead to treatment interruptions.

OBJECTIVE

This prospective cohort study aimed to evaluate acute skin toxicity and aesthetic outcomes following U-HFRT and to identify predictive factors.

METHODS

A total of 102 patients who underwent breast-conserving surgery or mastectomy for localized breast cancer were included. Adjuvant RT was delivered at a dose of 26 Gy in 5 fractions over 1 week. A sequential boost of 10 Gy in 5 fractions was delivered to the tumor bed in selected patients who received whole-breast irradiation. Skin toxicity was assessed according to the CTCAE 4.03 scale, and aesthetic outcomes were evaluated using the Harvard classification.

RESULTS

The median age was 59.5 years. No radiodermatitis (RD) was observed in 42% of patients, while grade 1 and grade 2 RD occurred in 38.2% and 18.6% of cases, respectively. Only one patient experienced grade 3 RD. The peak of toxicity occurred on the tenth day after RT. Induration of the tumor bed was noted in 9.6% of patients receiving a boost versus 14.6% without a boost. A breast volume ≥ 714 cm3 was significantly associated with the occurence of RD. Clinical target volume receiving 105% of the prescribed dose ≥ 4.23% was associated with grade 2 RD. Aesthetic outcomes improved after a median follow-up of 8 months.

CONCLUSION

U-HFRT appears to be a feasible and well-tolerated adjuvant treatment, with acceptable skin toxicity rates andfavorable aesthetic outcomes. However, a longer follow-up is necessary to assess long-term toxicities.