2024-SABCS-Takeaways - 13

 ECOG-ACRIN
Top Clinical Pearls in
RADIATION ONCOLOGY
from 2024 SABCS®
CLICK TO EXPAND
radiosensitizer in women
with residual triplenegative
breast cancer.
The maximum tolerated
dose of rucaparib during
RT was 300 mg daily,
which is 25% of the
approved monotherapy
dose. Radiation
dermatitis (RD) was the
most common toxicity,
and skin desquamation
was the most common
dose-limiting toxicity.
Concurrent treatment
with rucaparib and
adjuvant RT appeared to
lead to reduced localregional
progression.
But nearly half of
patients had poor
cosmesis by physician
assessment. Recurrence
was associated with
increased ctDNA levels,
but numbers were small,
and validation is needed.
Mepitel film, a siliconebased
wound dressing,
is widely used to reduce
RT-associated dermatitis
(RD) and improve
cosmesis, but there is
no universal consensus
for RD prophylaxis or
management. Alliance
A221803 (RF3-06)
found that mepitel
significantly reduced
RD in post-mastectomy
RT regardless of breast
reconstruction. Applying
the film before the
initial RT exposure and
changing the dressing
as needed nearly cut
incidence of grade ≥2
RD in half. There were no
significant differences
in acute acneiform
rash, pruritus, or skin
infection or in oncologic
outcomes, and no grade
4 or 5 adverse events
were reported. 
» Short-course RT may be more acceptable
to older women after breast-conserving
surgery than ET as a single-modality
treatment. Both treatments carry significant
toxicities which must be discussed with
patients via multidisciplinary and patientcentered
care teams.
» Tamoxifen might replace RT for low-risk
DCIS patients after breast-conserving surgery
because RT has no significant impact on
survival. RT omission should be a shared
decision between patient and physician.
» Adjuvant chest wall RT should be omitted in
most patients who meet the eligibility criteria
for SUPREMO.
» Mepitel film can reduce radiation dermatitis.
Looking Ahead
» Ongoing molecular
profiling trials may
help to better identify
subpopulations of
patients who are better
suited to RT or to ET.
» Longer-term follow up
for A221803 will assess
toxicity and reconstructive
outcomes following the
use of mepitel film. A secondary analysis
using blinded photographic analysis and RT
parameters may confirm initial findings that
the dressing is a new standard of care option
to prevent or reduce RD.
ON CHEST WALL RT AFTER MASTECTOMY
" Post-mastectomy radiation therapy
(PMRT) should be very rare in node-negative
patients. There simply isn't sufficient risk to
warrant PMRT in those cases. "
ATIF J. KHAN, MD, Attending Physician and Radiation
Oncologist, Memorial Sloan Kettering Cancer Center
December 10-13, 2024 | San Antonio, Texas
13
https://events.hubilo.com/sabcs2024/session/252200 https://events.hubilo.com/sabcs2024/session/252200
2024-SABCS-Takeaways

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