According to the most recent ASTRO whole breast fractionation guideline, the decision to offer HF-WBI should be independent of breast size (including central axis separation) provided that dose-homogeneity goals can be achieved. The guidelines recommend that the volume of breast tissue receiving gre...

Yes, absolutely! Even with the best dosimetric criteria, however, larger breasted patients will have more toxicity than their smaller-average breasted counterparts. However, there is a growing body of literature that breast size/volume is the independent predictor of acute and late toxicity, not fra...

This metric is antiquated and based upon the OCOG (Whelan et al., PMID 20147717) trial comparing 50 Gy to 42 Gy for whole breast RT.  For this trial performed in the mid-1990s, >25 cm separation was wisely excluded as it utilized 2D treatment planning (contour at central axis with dose presc...

MD Anderson randomized trial showed large breast have higher side effects irrespective of fractionation. Our own data showed with adherence to dose homogeneity even in large breast, acute grade 3 toxicity is very low with hypofractionation. We aim for dose homogeneity, partial breast with either IMP...