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Review
. 2025 May 21;17(5):e84561.
doi: 10.7759/cureus.84561. eCollection 2025 May.

Fractionating Boost Dose in Postoperative Breast Radiotherapy

Georgios Moschos  1 , Georgios Plataniotis  1
Affiliations
Review

Fractionating Boost Dose in Postoperative Breast Radiotherapy

Georgios Moschos et al. Cureus. .

Abstract

Mild hypofractionation in postoperative breast radiotherapy (RT) is now widely accepted as the preferred treatment, especially after the publication of the START trials in the United Kingdom. A boost to postoperative whole-breast irradiation (WBI) is indicated in selected patients to further reduce the risk of local recurrence. However, the exact dose and fractionation of radiation boost are subject to clinical debate. In the present work, we calculated the biologically effective doses (BEDs, linear-quadratic model) of WBI and boost RT prescribed in the most cited clinical trials to suggest an acceptable trial-based dose and fractionation for boost RT. WBI of a BED value of 65-75 Gy3.5 is required, and a boost-BED of 15-19 Gy3.5 is considered adequate. Longer boost RT schedules with a BED value of higher than 20 Gy3.5 do not offer additional benefits and might result in a higher risk for long-term post-radiation effects and waste of resources.

Keywords: clinical radiobiology; hypofractionated boost; hypofractionated breast radiotherapy; tumor bed boost; whole breast irradiation.

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Conflict of interest statement

Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

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