Top Line: Should we fast-forward breast boosts?
The Study: The COVID pandemic ignited MSKCC’s widespread adoption of FAST-Forward’s ultrahypofractionated whole breast radiation regimen of 5.2 Gy x 5 = 26 Gy regimen. But it didn’t stop there. They continued with a novel sequential tumor bed boost of 5.2 Gy × 1-2. This retrospective review included 311 patients (median age 71) treated between 2019–2022. Most (54%) received the 1-fraction boost, 9% received 2 fractions (typically for close or positive margins), and 38% no boost. At 3 years, overall survival was 96% and local recurrence-free survival 93%. Toxicities were acceptable overall but notably higher with the 2-fraction boost (acute ≥G2: 37% vs 11% with 1 fraction; late ≥G2: 23% vs 9%). As a result, the 2-fraction boost is no longer used.
TBL: A single-fraction 5.2 Gy boost following the FAST-Forward whole breast regimen achieves excellent disease control with minimal toxicity. | Chakraborty, Pract Radiat Oncol 2025
The Study: The COVID pandemic ignited MSKCC’s widespread adoption of FAST-Forward’s ultrahypofractionated whole breast radiation regimen of 5.2 Gy x 5 = 26 Gy regimen. But it didn’t stop there. They continued with a novel sequential tumor bed boost of 5.2 Gy × 1-2. This retrospective review included 311 patients (median age 71) treated between 2019–2022. Most (54%) received the 1-fraction boost, 9% received 2 fractions (typically for close or positive margins), and 38% no boost. At 3 years, overall survival was 96% and local recurrence-free survival 93%. Toxicities were acceptable overall but notably higher with the 2-fraction boost (acute ≥G2: 37% vs 11% with 1 fraction; late ≥G2: 23% vs 9%). As a result, the 2-fraction boost is no longer used.
TBL: A single-fraction 5.2 Gy boost following the FAST-Forward whole breast regimen achieves excellent disease control with minimal toxicity. | Chakraborty, Pract Radiat Oncol 2025