In addition, other studies have reported on the acute toxicities and
patient-reported outcome. One randomized controlled trial reported by
Paelink et al demonstrated no increase in moist desquamation after SIB
in a randomized trial of 167
patients(27). Another
randomized controlled trial compared hypofractionated radiotherapy with
SIB to conventionally fractionated radiotherapy with sequential boost.
The shorter regime resulted in better recovery of functional status and
faster recovery from
fatigue.(28).
The results from the IMPORT - High trial as presented at SABCS 2018
demonstrate that SIB (48 Gy) was associated with similar rates of
moderate to severe breast induration, shrinkage, distortion and change
in photographic appearance as a sequential boost (40 Gy + 16 Gy). A mild
to marked change in photographic appearance was observed in 12 patients
undergoing SIB versus 35 patients undergoing sequential boost
(p=0.03)(29).
The rationale of this
trial
If the results of FAST-FORWARD trial are positive, one-week whole breast
radiotherapy may be adopted as a standard of care in the UK. However,
this study has been conducted in a predominantly screen detected
Caucasian population. Advanced cancers, and also younger patients with
triple negative cancers are under-represented. In our population, the
majority of patients need a tumour bed boost and thus in order to have a
truly one-week course of radiotherapy, the tumour bed boost needs to be
delivered as a SIB.
Hence a trial investigating a one-week whole breast radiotherapy
schedule with a SIB for the tumour bed needs to be conducted in our
setting. We therefore plan to integrate a FAST-FORWARD like one-week
radiotherapy schedule with a SIB with appropriate dose reduction as done
in the IMPORT-High trial.