Skin Toxicity in Early Breast Cancer Patients Treated with Field-In-Field Breast Intensity-Modulated Radiotherapy versus Helical Inverse Breast Intensity-Modulated Radiotherapy: Results of a Phase III Randomised Controlled Trial.
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.
['Joseph|K|K|', 'Vos|L J|LJ|', 'Gabos|Z|Z|', 'Pervez|N|N|', 'Chafe|S|S|', 'Tankel|K|K|', 'Warkentin|H|H|', 'Ghosh|S|S|', 'Amanie|J|J|', 'Powell|K|K|', 'Polkosnik|L-A|LA|', 'Horsman|S|S|', 'MacKenzie|M|M|', 'Sabri|S|S|', 'Parliament|M B|MB|', 'Mackey|J|J|', 'Abdulkarim|B|B|']
D001943:Breast Neoplasms D018572:Disease-Free Survival D005260:Female D006801:Humans D000069451:Long Term Adverse Effects D008875:Middle Aged D009367:Neoplasm Staging D011855:Radiodermatitis D011879:Radiotherapy Dosage D011880:Radiotherapy Planning, Computer-Assisted D050397:Radiotherapy, Intensity-Modulated D012867:Skin
inverse-planned intensity-modulated radiotherapy early stage breast cancer Acute toxicity late toxicity forward field-in-field intensity-modulated radiotherapy