OC-0595: FAST-Forward phase 3 RCT of 1-week hypofractionated breast radiotherapy:3-year normal tissue effects

Brunt, Adrian Murray; Haviland, J.S.; Sydenham, M.; Alhasso, Abdulla; Bloomfield, D.; Chan, Charlie; Churn, Mark; Cleator, S.; Coles, Charlotte E.; Emson, Marie A.; Goodman, Andy; Griffin, Chandi; Harnett, A. N.; Hopwood, P.; Kirby, Alanah; Kirwan, CC; Morris, C.; Sawyer, Eleanor; Somaiah, Navita; Syndikus, Isabel; Wilcox, M.; Zotova, R.; Wheatley, Duncan; Bliss, Judith; Yarnold, John

doi:10.1016/s0167-8140(18)30905-8

Cited by 15 publications

(13 citation statements)

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“…Boost RT should be omitted to reduce fractions and/or complexity in the vast majority of patients unless those 40 years old and under, or over 40 years with significant risk factors for local relapse 25 Boost RT reduces the local recurrence risk without improving survival. An example of a significant risk factor is the presence of involved resection margins where further surgery is not possible.…”

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confidence: 99%

Recommendations for triage, prioritization and treatment of breast cancer patients during the COVID-19 pandemic

et al. 2020

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on behalf of the editorial board of The Breast. on behalf of the editorial board of The Breast. AbstractThe Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) associated disease outbreak seriously challenges globally all health care systems and professionals. Expert projections estimate that despite social distancing and lockdown being practiced, we have yet to feel the full impact of COVID-19. In this manuscript we provide guidance to prepare for the impact of COVID-19 pandemic on breast cancer patients and advise on how to triage, prioritize and organize diagnostic procedures, surgical, radiation and medical treatments.

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confidence: 99%

Recommendations for triage, prioritization and treatment of breast cancer patients during the COVID-19 pandemic

et al. 2020

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“…Instead, it recommends moving forward the delivery of ultrashort schemes. The RHEMA protocol is based on the results of U.K. studies FAST Trial [9], U.K. FAST‐FORWARD Trial [10, 11], and HAI‐5 [12].…”

Section: Resultsmentioning

confidence: 99%

GEICAM Guidelines for the Management of Patients with Breast Cancer During the COVID-19 Pandemic in Spain

et al. 2020

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Breast cancer (BC) is the most common cancer in women in Spain. During the COVID‐19 pandemic caused by the SARS‐CoV‐2 virus, patients with BC still require timely treatment and follow‐up; however, hospitals are overwhelmed with infected patients and, if exposed, patients with BC are at higher risk for infection and serious complications if infected. Thus, health care providers need to evaluate each BC treatment and in‐hospital visit to minimize pandemic‐associated risks while maintaining adequate treatment efficacy. Here we present a set of guidelines regarding available options for BC patient management and treatment by BC subtype in the context of the COVID‐19 pandemic. Owing to the lack of evidence about COVID‐19 infection, these recommendations are mainly based on expert opinion, medical organizations' and societies' recommendations, and some published evidence. We consider this a useful tool to facilitate medical decision making in this health crisis situation we are facing. Implications for Practice This work presents a set of guidelines regarding available options for breast cancer (BC) patient management and treatment by BC subtype in the context of the COVID‐19 pandemic. Owing to the suddenness of this health crisis, specialists have to make decisions with little evidence at hand. Thus, these expert guidelines may be a useful tool to facilitate medical decision making in the context of a worldwide pandemic with no resources to spare.

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“…Late responding tissues have long been recognized to be more sensitive to larger fraction sizes. That said, carefully designed regimens of 5 fractions or less have been safely employed in the palliative and definitive treatment settings across multiple malignancies, including breast cancer, with low rates of late toxicity [27–29]. Nevertheless, further investigation over a more prolonged period of time is needed to confirm whether the planning techniques we described and the regimen of 3, once daily fractions of 7.3 Gy (RBE1.1) will limit the risk of rib fractures and other late adverse effects and result in favorable long-term aesthetic outcomes [23].…”

Section: Discussionmentioning

confidence: 99%

3 fraction pencil-beam scanning proton accelerated partial breast irradiation: early provider and patient reported outcomes of a novel regimen

et al. 2019

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Background and purposeTo report dosimetry and early adverse effects, aesthetic, and patient-reported outcomes of a prospective study of 3-fraction pencil-beam scanning (PBS) proton accelerated partial irradiation (APBI).Materials and methodsEligibility included women age ≥ 50 years with estrogen receptor positive (ER+), sentinel lymph node negative invasive or in-situ breast cancer measuring ≤2.5 cm. The prescription was 21.9 Gy (RBE 1.1) in 3 daily fractions to the post-operative tumor bed with a 1 cm expansion. Toxicities were collected using Common Terminology Criteria for Adverse Events (CTCAE) version 4.0, 10-point Linear Analog Scale Assessment, Patient-Reported Outcomes Version of the CTCAE, and the Harvard Breast Cosmesis Scale.ResultsSeventy-six women were treated between 2015 and 2017. The median breast volume receiving 50% of prescription or more was 28%. Median mean heart, mean ipsilateral lung, and maximum skin dose were 0 Gy, 0.1 Gy, and 20.6 Gy, respectively. With a median follow-up of 12 months, no treatment-related toxicity grade ≥ 2 has been observed. Most common grade 1 adverse events were dermatitis (68%) and skin hyperpigmentation (18%). At 12 months, the only persistent toxicities were one patient with grade 1 breast edema and one patient with a grade 1 seroma. 90% of patients reported quality of life as ≥7 out of 10 (0 indicating “as bad as it can be” and 10 indicating “as good as it can be”) and 98% of patients reported excellent or good cosmesis.Conclusion3-fraction PBS proton APBI is well tolerated with low rates of physician and patient reported early adverse effects. Follow-up is ongoing to assess late toxicities and disease control outcomes. Further investigation of this novel adjuvant treatment strategy is warranted.

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OC-0595: FAST-Forward phase 3 RCT of 1-week hypofractionated breast radiotherapy:3-year normal tissue effects

Cited by 15 publications

References 0 publications

Recommendations for triage, prioritization and treatment of breast cancer patients during the COVID-19 pandemic

Recommendations for triage, prioritization and treatment of breast cancer patients during the COVID-19 pandemic

GEICAM Guidelines for the Management of Patients with Breast Cancer During the COVID-19 Pandemic in Spain

3 fraction pencil-beam scanning proton accelerated partial breast irradiation: early provider and patient reported outcomes of a novel regimen

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