ArticleAdvances in radiation oncology2026
Dosimetric Correlates of Acute Toxicities for Moderate Hypofractionated Whole-Breast Irradiation: Implications for ASTRO Planning Guidelines.
Article in Advances in radiation oncology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
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 and Materials: 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 3-dimensional conformal field-in-field planning. All plans adhered to ASTRO constraints (V105% < 200 cm Results: 600 patients were treated with HF WBI. Of those patients, 82.3% received a dose of 42.56 Gy in 16 fractions, whereas the remaining received 40.05 Gy in 15 fractions. Three-dimensional 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 % (cm Conclusions: Although skin related toxicities were infrequent and largely resolved by 1 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% (cm
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