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.

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.

One-Year Toxicity of Ultrahypofractionated Breast Radiotherapy (+/- Sequential Boost) and a Survey of Patient Experience

In March 2020, a 1-week hypofractionated adjuvant breast radiotherapy schedule, 26 Gy in 5 fractions, was implemented to reduce the risk of COVID 19 virus for patients and staff without compromising on cancer outcomes. This prospective observational study aims to report late toxicities at 1-year and to confirm feasibility and acceptability of this new schedule for patients. – Patient reported outcome measures were recorded at baseline, 3 months, 6 months and 1 year following treatment completion. The presence of breast pain, swelling, hypersensitivity and skin problems, arm or shoulder pain, restricted arm movement and arm swelling were recorded using the EORTC QLQ BR45. Virtual teleconferencing without video was utilized at baseline, 3 months, 6 months and 1-year. Patients were invited to use video at the 1-year assessment for a physician-based assessment. To assess the experience of patients, a survey including 12 questions related to understanding, experiences of and benefits of ultrahypofractionated radiotherapy was developed and patients were invited to participate at the 1-year consultation. In total, 135 consecutive patients were enrolled Mar - Aug 2020. 121/135 (90%) patients completed the 1-year toxicity assessment and at least one other assessment. 30/121 (25%) patients received a sequential boost. The majority of patients reported no toxicity or a mild toxicity at all three time points, 76% (83/109) at 3 months, 76% (82/108) at 6 months, and 82% (99/121) at 1-year. At 1 year 17% (20/121) of patients reported a moderate toxicity, the most common being breast pain (6/121). 2% (2/121) of patients reported a marked toxicity, both reported multiple marked toxicities including appearance of breast, firmness and skin changes. For the 30 patients who received a boost a moderate toxicity was reported by 17% (5/30) at 1 year and 3% (1/30) reported a marked toxicity. There was one confirmed case of ipsilateral recurrence at 1-year. Only 30/121 patients were open to using video for the 1-year physician-based assessment. Regarding patient reported experience 90% (101/112) felt informed about the 1-week radiotherapy schedule, and 88% (99/112) felt informed about possible side effects and 94% (105/122) felt supported by the medical team throughout their treatment course. Only 49% (55/112) reported they would have been open to video consultations. Most patients undergoing ultrahypofractionated breast radiotherapy experience no toxicities or mild toxicities. These data suggest that adding a sequential boost following 26 Gy in 5 fractions to the whole breast is safe and does not lead to unacceptable 1-year toxicity. Patient satisfaction with ultrahypofractionated treatment and virtual consultations without video was high. However, less than half of patients may be open to virtual consultations and breast examination using video. [ FROM AUTHOR] Copyright of International Journal of Radiation Oncology, Biology, Physics is the property of Pergamon Press - An Imprint of Elsevier Science and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

Implementation of FAST-Forward during COVID19: Report of acute skin toxicity /resource implications

Purpose or Objective In March 2020, a 1-week hypofractionated adjuvant breast radiotherapy schedule, 26 Gy in 5 fractions was adopted to reduce the risk of COVID 19 exposure for patients and staff without compromising on cancer outcomes. This study aimed to confirm acceptable acute toxicity rates for patients receiving this 1-week schedule (+/- sequential boost) and to quantify the positive impact of implementing this schedule on linac capacity. Materials and Methods This is a multicentre prospective observational study of consecutive patients receiving 26 Gy in 5 fractions adjuvant breast cancer radiotherapy (+/- boost) Mar-Aug 2020. Consensus was obtained on planning procedure protocols which included dose-volume evaluation and mandatory radiation quality assurance objectives. Standardised virtual consultations assessed acute skin toxicity during treatment and at weeks 1, 2, 3 and 4 post treatment using CTCAE V5 scoring criteria. Toxicity was compared between patients who received a boost and those that did not. The total number of linac minutes saved was estimated accounting for boost and DIBH use Results In total, 135 women were included, 33 (24%) received a boost. 128/135 (95%) patients, including 31/33 boost patients, completed at least 3/5 acute toxicity assessments. 0/128 (0%) reported moist desquamation not confined to skin folds or minor bleeding (grade 3 toxicity). 41/128 (31%) reported brisk erythema, moist desquamation confined to skin folds or breast swelling (Grade 2) and 63/128 (50%) reported faint erythema or dry desquamation (Grade 1) as their worst reported acute skin toxicity. The highest prevalence of grade 2 toxicity occurred at week 1 following treatment (19.5%), which reduced to 2.6% by week 4. There was no statistically significant difference in acute toxicity between boost and no boost patients (p= 1.00). Delivering a 1-week schedule to 135 patients over a six month period led to a saving of 21,300 linac minutes and 1485 hospital visits compared to delivering a moderately hypofractionated regimen of 3 weeks duration. 6,300 LINAC minutes were saved and 462 hospital visits avoided for patients > 70 years and cocooning under national guidance $Φg $Φg Conclusion This study demonstrates the feasibility of rapidly implementing a 1-week hypofractionated adjuvant breast radiotherapy schedule in clinical practice and how this landmark change has a considerable impact on linac capacity. This change in practice has ensured ongoing access to treatment for patients during the COVID-19 pandemic and greatly reduced the risks of infection for patients and staff. It further confirms acceptable acute skin toxicity even when followed by boost.