Intensity Modulated Radiation Therapy (IMRT) With Simultaneously Integrated Boost Shortens Treatment Time and Is Noninferior to Conventional Radiation Therapy Followed by Sequential Boost in Adjuvant Breast Cancer Treatment: Results of a Large Randomized Phase III Trial (IMRT-MC2 Trial)

Hörner-Rieber, Juliane; Förster, Tobias; Hommertgen, Adriane; Haefner, Matthias F.; Arians, Nathalie; König, Laila; Harrabi, Semi; Schlampp, Ingmar; Weykamp, Fabian; Lischalk, Jonathan W.; Heinrich, Vanessa; Weidner, N.; Hüsing, Johannes; Sohn, Christof; Heil, Jörrg; Hof, Holger; Krug, David; Debus, Jürgen

doi:10.1016/j.ijrobp.2020.12.005

Cited by 44 publications

(38 citation statements)

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“…A tumor bed boost is routinely recommended in premenopausal patients (LoE 1b/B/AGO++) and should be used in a risk-adapted manner in postmenopausal patients (LoE 2b/B/AGO+). If using conventionally fractionated whole-breast radiotherapy, the use of a simultaneous integrated boost is feasible, as shown by two recent randomized controlled trials (LoE 1b/B/AGO+) [67, 68]. Partial breast irradiation with interstitial brachytherapy, intensity-modulated radiotherapy over one-and-a-half weeks, or 3D conformal radiotherapy over 3 weeks are viable options for patients with early-stage, low-risk breast cancer (LoE 1a/A/AGO+).…”

Section: Adjuvant Radiotherapymentioning

confidence: 99%

AGO Recommendations for the Diagnosis and Treatment of Patients with Early Breast Cancer: Update 2021

et al. 2021

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Section: Adjuvant Radiotherapymentioning

confidence: 99%

AGO Recommendations for the Diagnosis and Treatment of Patients with Early Breast Cancer: Update 2021

et al. 2021

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“…Note that radiotherapy consisted of 3D conformal radiotherapy using a cobalt source. The toxicities reported in this study do not constitute a limiting factor for the growth of neoadjuvant radiotherapy, as modern radiotherapy techniques allow much better results by acting on several technical factors, such as the use of photon beams or even protons [12], 3D conformal radiotherapy or IMRT, an integrated boost dose [13], the lateral decubitus position [14], and respiratory gating [15]. This neoadjuvant strategy could also have the advantage of improving cosmetic results in the context of breast reconstruction [16].…”

Section: Discussionmentioning

confidence: 81%

Neoadjuvant Concurrent Radiotherapy and Chemotherapy in Early Breast Cancer Patients: Long-Term Results of a Prospective Phase II Trial

Jornet

Loap

Pierga

et al. 2021

Cancers

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Background: Neoadjuvant concurrent radiochemotherapy makes it possible to increase the breast conservation rate. This study reports the long term outcome of this treatment. Methods: From 2001 to 2003, 59 women with T2–3 N0–2 M0 invasive breast cancer (BC) not amenable to upfront breast conserving treatment (BCS) were included in this prospective, non-randomized phase II study. Chemotherapy (CT) consisted of four cycles of continuous 5-FU infusion and Vinorelbine. Starting concurrently with the second CT cycle, normofractionated RT was delivered to the breast and LN. Breast surgery was then performed. Results: Median follow-up (FU) was 13 years [3–18]. BCS was performed in 41 (69%) patients and mastectomy in 18 patients, with pathological complete response rate of 27%. Overall and distant-disease free survivals rates at 13 years were 70.9% [95% CI 59.6–84.2] and 71.5% [95% CI 60.5–84.5] respectively. Loco regional and local controls rates were 83.4% [95% CI 73.2–95.0] and 92.1% [95% CI 83.7–100], respectively. Late toxicity (CTCAE-V3) was assessed in 51 patients (86%) with a median follow-up of 13 years. Fifteen presented grade 2 fibrosis (29.4%), 8 (15.7%) had telangiectasia, and 1 had radiodermatitis. Conclusions: This combined treatment provided high long-term local control rates with limited side-effects.

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“…Many studies have compared the toxicity of 3D conformal radiation therapy vs. IMRT [ 13 , 14 , 15 , 16 ].…”

Section: Resultsmentioning

confidence: 99%

“…The phase III, multicenter, prospective randomized trial conducted by Horner-Rieber et al [ 15 ] in 502 patients evaluated IMRT breast radiation therapy with integrated boost (50.4 Gy/64.4 Gy) vs. 3DCRT with sequential boost (50.4 Gy/66.4 Gy). With a follow-up of 2 years, cosmetic evaluation using the Harvard and LENT SOMA criteria [ 17 ] did not demonstrate any significant difference in terms of atrophy/retraction, telangiectasia, fibrosis, lymphoedema, or breast oedema between the two arms.…”

Section: Resultsmentioning

confidence: 99%

Radiodermatitis and Fibrosis in the Context of Breast Radiation Therapy: A Critical Review

Allali

Kirova

2021

Cancers

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Background: Radiation therapy has been progressively improved in order to maintain a satisfactory tumour response, while reducing toxicity. We will review the incidence of radiodermatitis and fibrosis according to the various radiation and fractionation techniques. We will then focus on the various methods used to manage, prevent, and quantify this toxicity. Method: More than 1753 articles were identified using the various search terms. We selected 53 articles to answer the questions addressed in this study according to criteria set in advance. Result: The literature reports lower acute toxicity with IMRT compared to 3DCRT, but no significant differences in terms of late toxicities. Partial breast irradiation appears to be less effective in terms of local control with a higher rate of late toxicity. Intra operative radiation therapy appears to provide good results in terms of both local control and late toxicity. The hypofractionation has equivalent efficacy and safety to the normofractionated regimen, but with lower rates of radiodermatitis and fibrosis. The adddition of a boost, particularly a sequential boost, increases the risk of fibrosis and radiodermatitis during treatment. Conclusion: The development of IMRT has significantly reduced acute toxicity and has improved tolerability during treatment. Modified fractionation has reduced treatment time, as well as adverse effects.

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Intensity Modulated Radiation Therapy (IMRT) With Simultaneously Integrated Boost Shortens Treatment Time and Is Noninferior to Conventional Radiation Therapy Followed by Sequential Boost in Adjuvant Breast Cancer Treatment: Results of a Large Randomized Phase III Trial (IMRT-MC2 Trial)

Cited by 44 publications

References 46 publications

AGO Recommendations for the Diagnosis and Treatment of Patients with Early Breast Cancer: Update 2021

AGO Recommendations for the Diagnosis and Treatment of Patients with Early Breast Cancer: Update 2021

Neoadjuvant Concurrent Radiotherapy and Chemotherapy in Early Breast Cancer Patients: Long-Term Results of a Prospective Phase II Trial

Radiodermatitis and Fibrosis in the Context of Breast Radiation Therapy: A Critical Review

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