Pedal to the medal.

It doesn’t seem that accelerated partial breast irradiation is really catching on in most practices. There could be concerns about control and toxicity, but more likely it just doesn’t fit into the workflow. So, what if we worked backward? That’s what’s happening in the UK IMPORT LOW and FAST studies designed for an external beam approach. We’ve seen with UK FAST that 28.5 (but not 30) Gy in 5 weekly fractions to the whole breast had similar cosmesis to 50 Gy in 25 fractions. Here we have early cosmetic outcomes from the Canadian ACCEL trial evaluating 27 Gy in 5 daily fractions to the lumpectomy plus 1 cm-CTV and 7 mm-PTV using a 5-field IMRT technique. At one year, >90% of patients had excellent/good cosmesis, 40% had grade 1 fibrosis and none had grade 2+ fibrosis. TBL: Extremely hypofractionated partial breast irradiation with 27 Gy in 5 daily fractions has low rates of toxicity and good cosmesis at one year. | Grendarova, Pract Radiat Oncol 2019