Tres leches.

Getting ready for the Medicare radiation oncology APM draft? How great would it be if they just had a powerball-like session at ASTRO 2019? To add contenders, we now have more data from a phase 2 trial of 2-3 week hypofractionated breast radiation. Included were a very broad range of patients from stage 0 DCIS up to stage IIIA node-positive disease. The regimen consisted of 3.33 Gy x 11 = 36.63 Gy to the breast and even regional nodes when indicated (11%). The boost was 3.33 Gy x 4 = 13.32 Gy and was directed to a pretty typical 1-2 cm lumpectomy expansion. Nearly 150 patients were enrolled, with one-third of those being 50 years or younger. The rate of locoregional failure at 5 years was par for the course at only 2%. The rate of grade 2 acute skin toxicity was 30% with a single grade 3 skin toxicity. Late patient-reported outcomes mainly consisted of moderate pain and cosmetic changes. The challenge now is that we have several solid hypofractionation regimens to choose from. TBL: Whole breast radiation of 36.63 Gy in 11 fractions with a lumpectomy boost of 13.32 Gy in 4 fractions appears safe and effective for a broad range of breast cancer patients. | Gupta, Int J Radiat Oncol Biol Phys 2019