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Adjuvant breast inversely planned intensity-modulated radiotherapy with simultaneous integrated boost for early stage breast cancer

Results from a phase II trial

Adjuvante, invers geplante intensitätsmodulierte Strahlentherapie mit simultanem integrierten Boost für Brustkrebs im Frühstadium

Ergebnisse einer Phase-II-Studie

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Abstract

Purpose

To report early toxicity and 5‑year clinical outcomes of adjuvant breast inversely planned intensity-modulated radiotherapy with simultaneously integrated boost (IMRT-SIB) after breast-conserving surgery for early stage breast cancer patients.

Patients and methods

In all, 467 patients including 406 invasive breast cancer and 61 ductal carcinoma in situ (DCIS) were enrolled in a single institutional phase II trial. All patients underwent IMRT-SIB treatment to irradiate the whole breast and the tumor bed. Doses to whole breast and surgical bed were 45 and 60 Gy, respectively, delivered in 25 fractions over 5 weeks. The grade of maximum acute skin toxicity during treatment was recorded. Lung toxicity was noted within 6 months and patient-reported cosmetic outcomes were recorded at the 12 month follow-up after the end of radiotherapy. Clinical outcomes were assessed during follow-up.

Results

Median follow-up time was 5.46 years. Median age was 46 years old (range 22–70 years old). No patient with DCIS had a local recurrence or distant metastasis. Among 406 patients with invasive breast cancer, the unadjusted 5‑year actuarial rate of locoregional control was 98.7% (95% confidence interval [CI] 97.5–100), and distant metastasis-free survival 98.7% (95% CI 97.4–100), respectively. Acute skin toxicity was recorded at grade 0–1 in 76.5% of patients, and grade 2 in 23.5% of patients. None of these patients had grade 3 or more than grade 3 skin toxicity. Grade 1 pneumonitis was found in 25.3% of patients. Assessment of patient reported cosmetic outcomes at the 12 month follow-up showed good or excellent outcome in 86.5% of cases.

Conclusions

The use of inversely planned IMRT-SIB as part of breast-conserving therapy results in optimal 5‑year tumor control and minor early toxicities.

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Funding

This study was supported in part by the National Natural Science Foundation of China(81703025,81972846,81872457) and Shanghai Municipal Population and Family Planning Commission (20174Y0107).

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Authors and Affiliations

  1. Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China

    Jin Meng, Xin Mei, Xiaoli Yu, Ziqiang Pan, Jinli Ma, Xuejun Ma, Xiaomao Guo & Zhaozhi Yang

  2. Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China

    Jin Meng, Xin Mei, Xiaoli Yu, Ziqiang Pan, Jinli Ma, Xuejun Ma, Xiaomao Guo & Zhaozhi Yang

  3. Department of Radiation Oncology, The PLA Navy Anqing Hospial, Anhui, China

    Wenzhi Huang

  4. Department of Radiation Oncology, Shanghai Jiaotong University affiliated Ruijin Hospital, Shanghai, China

    Jiayi Chen

Authors
  1. Jin Meng
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  2. Wenzhi Huang
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  3. Xin Mei
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  4. Xiaoli Yu
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  5. Ziqiang Pan
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  6. Jinli Ma
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  7. Xuejun Ma
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  8. Jiayi Chen
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  9. Xiaomao Guo
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  10. Zhaozhi Yang
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Corresponding authors

Correspondence to Xiaomao Guo or Zhaozhi Yang.

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Conflict of interest

J. Meng, W. Huang, X. Mei, X. Yu, Z. Pan, J. Ma, X. Ma, J. Chen, X. Guo and Z. Yang declare that they have no competing interests.

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Meng, J., Huang, W., Mei, X. et al. Adjuvant breast inversely planned intensity-modulated radiotherapy with simultaneous integrated boost for early stage breast cancer. Strahlenther Onkol 196, 764–770 (2020). https://doi.org/10.1007/s00066-020-01611-1

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  • DOI: https://doi.org/10.1007/s00066-020-01611-1

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