Document Type : Original Article


1 Radiation Oncology Research Center, Cancer Institute, Tehran University of Medical Sciences, Tehran, Iran

2 Radiation Oncology Department, Hamadan University of Medical Sciences, Hamadan, Iran

3 Department of Radiation Oncology, Cancer Institute, Tehran University of Medical Sciences, Tehran, Iran


Background: Minimizing the overall treatment time is an issue of great importance in cancer management.  Concomitant boost is a way of decreasing the overall treatment time in breast cancer. The present prospective randomized study aimed to evaluate the feasibility and toxicity and cosmetic outcome of concomitant weekly boost in patients with breast cancer.
Method: Patients with breast cancer who underwent breast conservation surgery and were referred to our Radiation Oncology department from 2018 to 2019 were included in this randomized clinical trial. They were randomized to two groups both of which received conventional (50 Gy in 25 fraction, 5 days a week) whole breast irradiation (WBI) with 10 Gy boost dose to lumpectomy cavity. The boost dose in one group (n = 40) was delivered concomitantly on the 6th day of each week. The other group (n = 42) received the boost dose sequentially after completion of conventional WBI. Skin toxicity and cosmetic outcome was compared between the two groups according to CTCAE-4 skin complications and Harvard criteria.
Results: We did not observe any significant differences between the sequential and concomitant groups in terms of acute skin reaction within and one month after completion of radiotherapy. After one year of follow-up, no significant differences were seen concerning the cosmetic outcome between the two groups. No local recurrence was observed after 22 months of follow-up.
Conclusion: Accelerated radiotherapy with weekly concomitant boost in breast cancer patients was found to be feasible with an acceptable toxicity profile and cosmetic outcome during 1 year of follow-up.


This article has been accepted for publication and undergone full peer review but has not been through the copyediting, typesetting, pagination, and proofreading process, which may lead to differences between this version and the Version of Record. Please cite this article as doi:10.30476/mejc.2022.92071.1641

  1. Azria D, Belkacemi Y, Romieu G, Gourgou S, Gutowski M, Zaman K, et al. Concurrent or sequential adjuvant letrozole and radiotherapy after conservative surgery for early-stage breast cancer (CO-HO-RT): a phase 2 randomised trial. Lancet Oncol. 2010;11(3):258-65. doi: 10.1016/S1470-2045(10)70013-9.
  2. Becker-Schiebe M, Mengs U, Schaefer M, Bulitta M, Hoffmann W. Topical use of a silymarin-based preparation to prevent radiodermatitis : results of a prospective study in breast cancer patients. Strahlenther Onkol. 2011;187(8):485-91. doi: 10.1007/s00066-011-2204-z.
  3. Jager JJ, Langendijk JA, Dohmen JP, Schreutelkamp IL, Volovics L, van Engelshoven JM, et al. Mammography in the follow-up after breast-conserving treatment in cancer of the breast: suitability for mammographic interpretation, validity and interobserver variation. Br J Radiol. 1995;68(811):754-60. doi: 10.1259/0007-1285-68-811-754.
  4. De Santis MC, Bonfantini F, Di Salvo F, Dispinzieri M, Mantero E, Soncini F, et al. Factors influencing acute and late toxicity in the era of adjuvant hypofractionated breast radiotherapy. Breast. 2016;29:90-5. doi: 10.1016/j.breast.2016.07.013.
  5. Vassilis K, Ioannis G, Anna Z, Christina A, Christos A, John K, et al. A unique hypofractionated radiotherapy schedule with 51.3 Gy in 18 fractions three times per week for early breast cancer: outcomes including local control, acute and late skin toxicity. Breast Cancer. 2017;24(2):263-70. doi: 10.1007/s12282-016-0697-0.
  6. Poortmans P. Evidence based radiation oncology: breast cancer. Radiother Oncol. 2007;84(1):84-101. doi: 10.1016/j.radonc.2007.06.002.
  7. Meehan J, Gray M, Martínez-Pérez C, Kay C, Pang LY, Fraser JA, et al. Precision medicine and the role of biomarkers of radiotherapy response in breast cancer. Front Oncol. 2020;10:628. doi: 10.3389/fonc.2020.00628.
  8. Ellerbroek N, Martino S, Mautner B, Tao ML, Rose C, Botnick L. Breast-conserving therapy with adjuvant paclitaxel and radiation therapy: feasibility of concurrent treatment. Breast J. 2003;9(2):74-8. doi: 10.1046/j.1524-4741.2003.09203.x.
  9. Dunst J, Steil B, Furch S, Fach A, Bormann G, Marsch W. Herpes zoster in breast cancer patients after radiotherapy. Strahlenther Onkol. 2000;176(11):513-6. doi: 10.1007/pl00002318.
  10. Ghannam AAEA, Khedr RAEG. An accelerated hypofractionated schedule with a daily concomitant boost after breast conservation surgery: The feasibility and toxicity. J Egypt Natl Canc Inst. 2016;28(1):39-44. doi: 10.1016/j.jnci.2016.01.002.
  11. Corvò R, Ricchetti F, Doino D, Torielli P, Agostinelli S, Cavagnetto F, et al. Adjuvant hypofractionated radiotherapy with weekly concomitant boost for women with early breast cancer: the clinical experience at Genoa university. Anticancer Res. 2010;30(11):4749-53.
  12. Cante D, Rosa La Porta M, Casanova-Borca V, Sciacero P, Girelli G, et al. Accelerated hypofractionated adjuvant whole breast radiotherapy with concomitant photon boost after conserving surgery for early stage breast cancer: a prospective evaluation on 463 patients. Breast J. 2011;17(6):586-93. doi: 10.1111/j.1524-4741.2011.01159.x.
  13. Karasawa K, Kunogi H, Hirai T, Hojo H, Hirowatari H, Izawa H, et al. Comparison of hypofractionated and conventionally fractionated whole-breast irradiation for early breast cancer patients: A single-institute study of 1,098 patients. Breast Cancer. 2014;21(4):402-8. doi: 10.1007/s12282-012-0406-6.
  14. Landoni V, Giordano C, Marsella A, Saracino B, Petrongari M, Ferraro A, et al. Evidence from a breast cancer hypofractionated schedule: late skin toxicity assessed by ultrasound. J Exp Clin Cancer Res. 2013;32(1):80. doi: 10.1186/1756-9966-32-80.
  15. Harris S. Radiotherapy for early and advanced breast cancer. Int J Clin Pract. 2001;55(9):609-12.
  16. Hehr T, Budach W, Paulsen F, Gromoll C, Christ G, Bamberg M. Evaluation of predictive factors for local tumour control after electron-beam-rotation irradiation of the chest wall in locally advanced breast cancer. Radiother Oncol. 1999;50(3):283-9. doi: 10.1016/s0167-8140(99)00016-x.
  17. Kirova YM, Caussa L, Granger B, Savignoni A, Dendale R, Campana F, et al. Évaluation monocentrique de la tolérance de l’association concomitante de trastuzumab et de radiothérapie. Cancer/Radiotherapie. 2009;13(4):276-80. doi: 10.1016/j.canrad.2009.02.008.
  18. Nandi M, Mahata A, Mallick I, Achari R, Chatterjee S. Hypofractionated radiotherapy for breast cancers--preliminary results from a tertiary care center in eastern India. Asian Pac J Cancer Prev. 2014;15(6):2505-10. doi: 10.7314/apjcp.2014.15.6.2505.
  19. Hannan R, Thompson RF, Chen Y, Bernstein K, Kabarriti R, Skinner W, et al. Hypofractionated whole-breast radiation therapy: does breast size matter? Int J Radiat Oncol Biol Phys. 2012;84(4):894-901. doi: 10.1016/j.ijrobp.2012.01.093.
  20. Yarnold, J. Adjuvant radiotherapy. In: Yarnold, J. Early and locally advanced breast cancer: diagnosis and treatment. Cardiff (UK): National Collaborating Centre for Cancer; 2009. p.159-160.
  21. Levitan D. New ASTRO Guidelines Recommend Hypofractionated Breast Irradiation [Internet]. [cited 2021 Jul 17]. Available from: