Intensity modulated radiation therapy for breast cancer: current perspectives

Abstract

BackgroundOwing to highly conformed dose distribution, intensity modulated radiation therapy (IMRT) has the potential to improve treatment results of radiotherapy (RT). Postoperative RT is a standard adjuvant treatment in conservative treatment of breast cancer (BC). The aim of this review is to analyze available evidence from randomized controlled trials (RCTs) on IMRT in BC, particularly in terms of reduction of side effects.MethodsA literature search of the bibliographic database PubMed, from January 1990 through November 2016, was performed. Only RCTs published in English were included.ResultsTen articles reporting data from 5 RCTs fulfilled the selection criteria and were included in our review. Three out of 5 studies enrolled only selected patients in terms of increased risk of toxicity. Three studies compared IMRT with standard tangential RT. One study compared the results of IMRT in the supine versus the prone position, and one study compared standard treatment with accelerated partial breast IMRT. Three studies reported reduced acute and/or late toxicity using IMRT compared with standard RT. No study reported improved quality of life.ConclusionIMRT seems able to reduce toxicity in selected patients treated with postoperative RT for BC. Further analyses are needed to better define patients who are candidates for this treatment modality.

Hypofractionated radiation in older women with breast cancer

“…This technique of dose modulation has the potential to further decrease unwanted morbidity in patients treated with radiation therapy (RT) in certain disease sites while increasing RT dose homogeneity in the breast. 11 While Canadian and European trials of dose modulation showed decreased skin toxicity and improved cosmetic outcomes, dose modulation in those trials was considered to be more simple than dose modulation used in the United States. An NCDB analysis revealed increased use of IMRT from 5.3% in 2004 to 11.6% in 2009, and subsequent stabilization in 2011 at 10.7%.…”

“…Concurrent with the de‐escalation of radiation duration, more advanced radiation techniques known as intensity‐modulated radiation therapy (IMRT) have emerged. This technique of dose modulation has the potential to further decrease unwanted morbidity in patients treated with radiation therapy (RT) in certain disease sites while increasing RT dose homogeneity in the breast . While Canadian and European trials of dose modulation showed decreased skin toxicity and improved cosmetic outcomes, dose modulation in those trials was considered to be more simple than dose modulation used in the United States.…”

Hyperthermia and Radiotherapy Combination for Locoregional Recurrences of Breast Cancer: A Review

“…With cumulative RT doses, serious late complications such as fibrosis, osteonecrosis, rib fracture and brachial plexopathy can occur more frequently [9,19]. Novel RT approaches such as intensity modulated radiation therapy and image-guided RT can minimize radiation exposure to uninvolved critical structures and enables less toxicity profile while increasing the applied dose [20]. Combination therapies with chemotherapeutics and targeted agents as radiosensitizers are another form of increasing therapeutic gain and proved benefit in many cancer sites as the standard treatment modality [21][22][23].…”

CPAP (Continuous Positive Airway Pressure) is an effective and stable solution for heart sparing radiotherapy of left sided breast cancer

“…Multiple studies have been done using techniques to improve the dosimetry of left sided breast radiotherapy. These include two main solutions: improving dosimetry through treatment planning [2,3] (IMRT, proton therapy etc.) or distancing the heart physically through technological advances [4,5] (Automated Breathing Control -ABC, Deep inspiration breath hold (DIBH)).…”