Give me a boost.

A serious boost. The Young Boost Trial was designed in 2004 to determine whether a boost of 24 Gy instead of 16 Gy (as used in the EORTC 22881) following whole breast radiation could overcome the persistently high recurrence rates seen among women ≤ 50 years. Remember, recurrence rates were as high as 9% for those ages 41-50 and 15% for those 40 or younger despite a 16 Gy boost. The primary endpoint of local recurrence still hasn’t been reported, but we're bringing you the secondary endpoint of cosmesis as measured by three entities: physician, patient and automated software analysis of digital images. As expected, at a median follow-up of just over 4 years for < 2400 Western European enrollees, rates of satisfactory cosmesis were significantly better across all measures with the 16 versus 24 Gy boost: 63-67% versus 52-55%, respectively. The biggest predictors of poor cosmesis were poorer cosmesis at baseline (OR 1.8 per category...because radiation’s not gonna fix anything), a 24 Gy boost dose (OR 1.8), adjuvant chemo (OR 1.6), boost volume (OR 1.04 per 10 cc), and highest of all a photon versus electron boost (OR 2.0). TBL: Whatever impact a higher breast boost dose has on local control in younger women, we’ll know it comes at the expense of approximately 1 in 10 of them being less satisfied with cosmesis. | Brouwers, Radiother Oncol 2018