K Joseph1, L J Vos2, Z Gabos1, N Pervez1, S Chafe1, K Tankel1, H Warkentin3, S Ghosh4, J Amanie1, K Powell3, L-A Polkosnik3, S Horsman4, M MacKenzie3, S Sabri5, M B Parliament1, J Mackey4, B Abdulkarim6. 1. Division of Radiation Oncology, Department of Oncology, University of Alberta & Cross Cancer Institute, Edmonton, Alberta, Canada. 2. Alberta Cancer Clinical Trials, Cross Cancer Institute, Edmonton, Alberta, Canada. 3. Division of Medical Physics, Department of Oncology, University of Alberta & Cross Cancer Institute, Edmonton, Alberta, Canada. 4. Division of Medical Oncology, Department of Oncology, University of Alberta & Cross Cancer Institute, Edmonton, Alberta, Canada. 5. Division of Experimental Oncology, Department of Oncology, University of Alberta & Cross Cancer Institute, Edmonton, Alberta, Canada. 6. Division of Radiation Oncology, Department of Oncology, University of Alberta & Cross Cancer Institute, Edmonton, Alberta, Canada. Electronic address: bassam.abdulkarim@mcgill.ca.
Abstract
AIMS: Skin toxicity is a common adverse effect of breast radiotherapy. We investigated whether inverse-planned intensity-modulated radiotherapy (IMRT) would reduce the incidence of skin toxicity compared with forward field-in-field breast IMRT (FiF-IMRT) in early stage breast cancer. MATERIALS AND METHODS: This phase III randomised controlled trial compared whole-breast irradiation with either FiF-IMRT or helical tomotherapy IMRT (HT-IMRT), with skin toxicity as the primary end point. Patients received 50 Gy in 25 fractions and were assessed to compare skin toxicity between treatment arms. RESULTS: In total, 177 patients were available for assessment and the median follow-up was 73.1 months. Inverse IMRT achieved more homogeneous coverage than FiF-IMRT; erythema and moist desquamation were higher with FiF-IMRT compared with HT-IMRT (61% versus 34%; P < 0.001; 33% versus 11%; P < 0.001, respectively). Multivariate analysis showed large breast volume, FiF-IMRT and chemotherapy were independent factors associated with worse acute toxicity. There was no difference between treatment arms in the incidence of late toxicities. The 5-year recurrence-free survival was 96.3% for both FiF-IMRT and HT-IMRT and the 5-year overall survival was 96.3% for FiF-IMRT and 97.4% for HT-IMRT. CONCLUSIONS: Our study showed significant reduction in acute skin toxicity using HT-IMRT compared with FiF-IMRT, without significant reduction in late skin toxicities. On the basis of these findings, inverse-planned IMRT could be used in routine practice for whole-breast irradiation with careful plan optimisation to achieve the required dose constraints for organs at risk.
RCT Entities:
AIMS: Skin toxicity is a common adverse effect of breast radiotherapy. We investigated whether inverse-planned intensity-modulated radiotherapy (IMRT) would reduce the incidence of skin toxicity compared with forward field-in-field breast IMRT (FiF-IMRT) in early stage breast cancer. MATERIALS AND METHODS: This phase III randomised controlled trial compared whole-breast irradiation with either FiF-IMRT or helical tomotherapy IMRT (HT-IMRT), with skin toxicity as the primary end point. Patients received 50 Gy in 25 fractions and were assessed to compare skin toxicity between treatment arms. RESULTS: In total, 177 patients were available for assessment and the median follow-up was 73.1 months. Inverse IMRT achieved more homogeneous coverage than FiF-IMRT; erythema and moist desquamation were higher with FiF-IMRT compared with HT-IMRT (61% versus 34%; P < 0.001; 33% versus 11%; P < 0.001, respectively). Multivariate analysis showed large breast volume, FiF-IMRT and chemotherapy were independent factors associated with worse acute toxicity. There was no difference between treatment arms in the incidence of late toxicities. The 5-year recurrence-free survival was 96.3% for both FiF-IMRT and HT-IMRT and the 5-year overall survival was 96.3% for FiF-IMRT and 97.4% for HT-IMRT. CONCLUSIONS: Our study showed significant reduction in acute skin toxicity using HT-IMRT compared with FiF-IMRT, without significant reduction in late skin toxicities. On the basis of these findings, inverse-planned IMRT could be used in routine practice for whole-breast irradiation with careful plan optimisation to achieve the required dose constraints for organs at risk.
Authors: Hae Jin Park; Kwang-Ho Cheong; Taeryool Koo; Me Yeon Lee; Kyoung Ju Kim; Soah Park; Taejin Han; Sei-Kwon Kang; Boram Ha; Jai-Woong Yoon; Me Young Kim; Hoonsik Bae Journal: In Vivo Date: 2022 Jul-Aug Impact factor: 2.406
Authors: M C T Batenburg; M Bartels; W Maarse; A Witkamp; H M Verkooijen; H J G D van den Bongard Journal: Breast J Date: 2022-04-16 Impact factor: 2.269
Authors: Raluca Stoian; Thalia Erbes; Constantinos Zamboglou; Jutta Scholber; Mark Gainey; Ilias Sachpazidis; Erik Haehl; Simon K B Spohn; Vivek Verma; David Krug; Alexander Rühle; Ingolf Juhasz-Böss; Anca-Ligia Grosu; Nils H Nicolay; Tanja Sprave Journal: Strahlenther Onkol Date: 2021-04-30 Impact factor: 3.621