Radiotherapy Breast Boost With Reduced Whole-Breast Dose Is Associated With Improved Cosmesis: The Results of a Comprehensive Assessment From the St. George and Wollongong Randomized Breast Boost Trial

Tumor Bed Boost Integration during Whole Breast Radiotherapy: A Review of the Current Evidence

“…A non-significant decrease in physician-based cosmetic results was observed in the boost arm and a higher rate of fat necrosis [13]. The St. George and Wollongong (SGW) trial randomized 688 breast cancer patients to receive conventionally fractionated WBRT (50 Gy/25 fr) with no boost vs. lower dose WBRT (45 Gy/25 fr) and a sequential boost of 16 Gy/8 fr delivered with electrons [14]. In the 6-year analysis, no difference in terms of local control could be detected between treatment arms [15].…”

“…In the 6-year analysis, no difference in terms of local control could be detected between treatment arms [15]. Nevertheless, the boost arm had improved overall cosmetic results as assessed by an external expert panel (79 vs. 68%; p = 0.016) and a lower (not statistically significant) breast retraction assessment score, maybe due to the reduced whole-breast dose [14]. However, generally, the application of a tumor bed boost dose is recommended for patients below the age of 40 having a large tumor, close surgical margins, high-grade invasive or in situ ductal tumors, a high proliferation index, hormone receptor-negative tumors, and an extensive intraductal component [2].…”

The long-term outcome of adjuvant hypofractionated radiotherapy and conventional fractionated radiotherapy after breast-conserving surgery for early breast cancer: a prospective analysis of 107 cases

“…In the previous study, due to the concern that tumor bed boost might compromise the aesthetic outcome in the breast, this step was not performed. However, a randomized trial in Australia revealed that the application of either a regimen of the whole-breast irradiation at 45-50 Gy followed by a tumor bed boost of 16 Gy/8 fractions or a regimen of the wholebreast irradiation at 45-50 Gy without a tumor bed boost showed no significant difference in the 5-year rates of patients with excellent and good cosmetic results (22). In Japan, clinical studies on boost irradiation of patients with positive margins obtained favorable results without severe toxicity (23), and multiple studies on (24-26) HF followed by a tumor bed boost also had favorable cosmetic effects.…”

Breast irradiation causes pallor in the nipple‐areolar complex in women with Celtic skin type (result from the St. George and Wollongong randomised breast boost trial)

“…Hau et al . assessed cosmetic outcomes using both subjective and objective means including patient self‐assessment, live clinician assessment as well as computer BCCT.core analysis . Subjective assessment utilised the 4‐point scale developed by Harris et al .…”