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Background: Hypofractionated whole breast radiotherapy (HFWBRT) showed comparable efficacy and safety to conventional fractionated radiotherapy. Dose and fractionation of the tumor bed boost to be integrated during HF-WBRT schedules is still to be determined. Aim: to investigate the clinical feasibility of HF-WBRT with simultaneous integrated boost (SIB), in early breast cancer patients who underwent breast conserving surgery (BCS). Methods: This single arm prospective study included 40 female patients with pathologically proven stage I-II breast cancer following BCS with high risk factors. Patients received 3D conformal radiotherapy (3DCRT) with field in field (FIF) technique. The whole breast received a dose of 40 gray (Gy) over 15 fractions for 3 weeks with an additional SIB dose of 8 Gy over 15 fractions to be give  daily during WBRT. Radiation toxicities were graded using the common terminology criteria for adverse events (NCI-CTCAE) scale version 4.03. Cosmetic outcome was assessed using Harvard cosmetic score. Kaplan Meier method was used to estimate the 3- year disease free (DFS) and overall survival (OS). Results: The median age at presentation was 48 years (range 33-68). No reported grade 3 or 4 toxicities. Grade 1 and 2 radiation dermatitis affected 80% of the patients, breast pain was observed in 62.5% of the patients while 25% had radiation pneumonitis. Most of the patients (95%) had excellent and good cosmetic outcomes. At 3 years the estimated DFS was 95% and OS was 97.5 %. Conclusion: WBRT-SIB using 3DCRT with FIF technique is clinically feasible for early stage breast cancer patients.

Hypofractionated Whole Breast Radiotherapy with Simultaneous Integrated Boost Following Breast Conservative Surgery for Early Breast Cancer