Purpose: ASTRO's 2018 guidelines for hypofractionated whole breast irradiation (HF WBI) recommend limiting high dose regions to improve dose homogeneity and minimize toxicity.However, correlation of these guidelines with clinical outcomes remains limited.This study investigates the relationship between dose volume parameters and acute toxicities including pain, erythema, edema and moist desquamation in patients treated with HF WBI in accordance with ASTRO 2018 guidelines. Methods:We retrospectively reviewed patients treated from 2018 to 2023 with HF WBI (42.56 Gy in 16 fractions or 40.05 Gy in 15 fractions) between 2018 and 2023 using 3D conformal field in field planning.All plans adhered to ASTRO constraints (V105% < 200 cc; V107% < 2 cc).Acute toxicities were prospectively scored using the CTCAE V5.0 at weekly on treatment visits (OTVs) and at one month follow up.Logistic regression analyses identified predictors of grade 2 toxicities.Results: 600 patients were treated with HF WBI.82.3% of the patients received a dose of 42.56 Gy in 16 fractions, while the remaining received 40.05 Gy in 15 fractions.3D field-in-field planning was used in all patients and 73.7% received a boost.Moderate to severe pain (grade 2) occurred in 29.7% of patients during treatment despite compliance with ASTRO guidelines.In contrast grade 2 erythema, edema and moist desquamation were observed in < 5% of patients.Multivariate analysis identified V105 % (cc) 50 cc, V105 %(%) 5% and BMI 30 as independent predictors of grade 2 pain, which decreased by 30% when V105 % (cc) < 50 cc and by 18.5% when V105 %(%) < 5%.Conclusions: While skin related toxicities were infrequent and largely resolved by one month, pain remained a prevalent side effect of HF WBI.These findings suggest that ASTRO's current V105% thresholds may be too permissive for pain mitigation.Stricter limits of V105%(cc) < 50 cc and V105%(%) < 5% may better protect patients from treatment related discomfort and warrant consideration in future guideline updates.
Dumane et al. (Sun,) studied this question.