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ORIGINAL ARTICLES
Year : 2022  |  Volume : 5  |  Issue : 1  |  Page : 8-12

FAST-Forward trial in breast cancer: A prospective pilot study addressing dosimetric and practice feasibility in Indian scenario


1 Department of Radiation Oncology, Mahatma Gandhi Cancer Hospital and Research Institute, Visakhapatnam, Andhra Pradesh, India
2 Department of Radiation Oncology, Acharya Harihar Post Graduate Institute of Cancer, Cuttack, Odisha, India
3 Department of Medical Physics, Mahatma Gandhi Cancer Hospital and Research Institute, Visakhapatnam, Andhra Pradesh, India

Correspondence Address:
Dr. Kanhu Charan Patro
Department of Radiation Oncology, Mahatma Gandhi Cancer Hospital and Research Institute, Visakhapatnam, Andhra Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jco.jco_39_21

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Aims: To evaluate the dosimetry and practice feasibility in patients of breast carcinoma undergoing postoperative radiotherapy (RT) to the whole breast (WB) as per the FAST-Forward trial protocol. Materials and Methods: A total of 10 patients aged more than 18 years with histopathology proved early stage invasive carcinoma of breast after breast conservation surgery (BCS) were considered for receiving adjuvant RT to the WB with a total dose of 26 Gy in five fractions at a rate of 5.2 Gy per fraction delivered over 5 days. Boost to the tumor bed with a dose of 10 Gy in four fractions was delivered to the BCS cavity with adequate margin as per protocol. Targets were contoured according to the ESTRO guidelines. Heart and ipsilateral lung were considered as organs at risk. Target coverage and dose to the heart and ipsilateral lung were evaluated by dose–volume histograms. All patients were evaluated clinically for acute toxicity such as skin reaction and breast pain weekly once during RT, at the completion of RT, and at 3 months of follow-up. Results: Out of 10 patients, eight patients had right-sided breast carcinoma. As per protocol, we were able to achieve a dose constraint to ipsilateral lung in only three patients (V30%(7.8Gy) ≤ 17%). The range of excess dose variations in remaining seven patients was between 0.4% and 4.5%. Dose constraint to the heart has been achieved in all right-sided breast cancer patients (V25%(6.5Gy) ≤ 5). In left-sided breast cancer patients, an excess range of dose variation was between 0.8% and 2%. Only one patient developed grade III skin reaction at the end of RT (Common Toxicology Criteria for Acute Effects Grade 1). Conclusion: The FAST-Forward trial protocol (26 Gy in five fractions) can be effectively delivered in patients with postoperative invasive early stage breast cancer. The hurdle we faced was lung dose constraint, which was difficult to achieve in certain patients.


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