Randomised trial of standard 2D radiotherapy (RT) versus intensity modulated radiotherapy (IMRT) in patients prescribed breast radiotherapy

Donovan, Ellen M.; Bleakley, Natalie; Denholm, Erica; Evans, Philip; Gothard, Lone; Hanson, Jane; Peckitt, Clare; Reise, Stephanie; Ross, Gill; Sharp, Grace; Symonds‐Tayler, Richard; Tait, Diana; Yarnold, John

doi:10.1016/j.radonc.2006.12.008

Cited by 436 publications

(264 citation statements)

References 28 publications

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“…Retrospective re-grading of skin reactions in the present pilot study, applying RTOG criteria, produced comparable rates: 3% grade 0, 67% grade 1, 30% grade 2 and no grade 3 or 4 toxicity. However, differences in breast size and radiation dosimetry limit the reliability of this comparison [10,11]. A correlation between breast size and acute toxicity was reported in the RTOG 97-13 study, with small-breasted women developing 11e21% grade 2 or higher skin toxicity compared with 43e50% in large-breasted women.…”

Section: Discussionmentioning

confidence: 98%

“…However, the same limitations apply to this comparison as discussed for acute skin toxicities. In addition, the nine (30%) patients in the pilot study treated with full (three-dimensional) dose compensation may have developed slightly lower levels of late normal tissue effects than if standard two-dimensional dosimetry had been used [10,11]. Late changes in normal tissues are also more sensitive to fraction size than early skin reactions [12].…”

Section: Discussionmentioning

confidence: 98%

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Acute Toxicity and 2-year Adverse Effects of 30 Gy in Five Fractions over 15 Days to Whole Breast after Local Excision of Early Breast Cancer

et al. 2008

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ABSTRACT:Aims: A pilot study was undertaken with the aim of documenting acute skin reactions and 2-year late adverse effects of a five-fraction course of adjuvant whole breast radiotherapy delivered over 15 days after local tumour excision of early breast cancer. Materials and methods: Thirty women with early invasive breast cancer aged R 50 years with a pathological tumour size !3 cm, complete microscopic resection, negative axillary node status and no requirement for cytotoxic therapy were prescribed 30 Gy in five fractions over 15 days to the whole breast using tangential 6e10 MV X-ray beams and three-dimensional dose compensation with written informed consent. Post-surgical baseline photographs of the breasts were taken, and acute skin erythema and moist desquamation were each scored weekly for 7 weeks using four-point graded scales (grade 0 [ none, 1 [ mild, 2 [ moderate, 3 [ severe). This was followed by an annual clinical assessment, including repeat photographs at 2 years. Results: Nine patients (30%, 95% confidence interval 14.7e49.4%) developed grade 2 erythema, with the remaining 21 patients developing milder degrees of reaction. Four (13.3%, 95% confidence interval 3.7e30.7) patients developed moist desquamation, grade 1 in three women and grade 2 in the fourth. At 2 years after treatment, 23/30 (77%) patients scored no change in photographic breast appearance compared with the pre-treatment baseline; seven (23%, 95% confidence interval 9.9e42.3) scored a mild change in breast appearance, and none developed a marked change. After a mean follow-up of 3.1 years (standard deviation 0.37, range 2.1e3.9 years) there have been no ipsilateral local tumour relapses. Conclusions: Further evaluation of a five-fraction regimen of adjuvant whole breast radiotherapy in a phase III randomised trial is justified, including a regimen delivered in a total of 5 days. Martin, S. et al.

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Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 98%

Acute Toxicity and 2-year Adverse Effects of 30 Gy in Five Fractions over 15 Days to Whole Breast after Local Excision of Early Breast Cancer

et al. 2008

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“…Change in photographic breast appearance at 2 years was used to define the late adverse effect caused by radiotherapy in this study. This endpoint has been well established and validated in randomised clinical trials, indicating it to be sensitive to small (<10%) differences in randomised total dose [1][2][3]7,11]. The 2-year timepoint is predictive of the relative effects of randomised groups at longer follow up, even though the absolute rate of adverse effects continues to rise for at least a decade and probably for life [7,22,23].…”

Section: Discussionmentioning

confidence: 99%

“…Residual concerns include the impact of dose inhomogeneity on the risk of adverse effects after hypofractionated schedules, so-called 'treble trouble' [8][9][10]. A causal association between breast dose inhomogeneity and the risk of late tissue complications is suggested by the 5 years follow up results of a UK randomised trial (N = 306) comparing 2D versus 3D breast dosimetry [11]. Assuming dose distribution matters, it is not known if residual dose inhomogeneity in patients treated using 3D dose compensation contributes to a higher risk of adverse effects after hypofractionated radiotherapy than after standard regimens.…”

Section: Introductionmentioning

confidence: 99%

The impact of dose heterogeneity on late normal tissue complication risk after hypofractionated whole breast radiotherapy

Tsang

Haviland

Venables

et al. 2012

Radiotherapy and Oncology

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a b s t r a c tBackground and purpose: Linear quadratic models predict that hypofractionation increases the biological effect of physical dose inhomogeneity. The clinical significance of this effect was tested retrospectively in a trial of adjuvant breast hypofractionation. Methods: The UK FAST trial randomised 915 women after breast conservation surgery between standard fractionation and two dose levels of a 5-fraction regimen delivering 5.7 or 6.0 Gy fractions in 5 weeks, using 3D dosimetry. Logistic regression tested for association between the absolute volumes receiving different isodose level >100% of prescribed dose (hotspots) and the risk of change in 2-year photographic breast appearance. The strength of this association was compared between control and hypofractionated groups. Results: Three hundred and ninety datasets from 11 participating centres were available for analysis. At 2 years post-randomisation, 81 (20.8%) had mild change and 24 (6.2%) had marked change in photographic breast appearance. After adjusting for breast size and surgical deficit, there was no statistically significant association between the risk of 2-year change in breast appearance and dose inhomogeneity in either the control or hypofractionated schedules, according to the various definitions of hotspots analysed. The magnitude of the effect of dosimetry on 2-year change in breast appearance did not vary significantly between control and hypofractionated schedules for any of the dosimetry parameters (p > 0.05 for all heterogeneity tests). Conclusion: Dose inhomogeneity had no greater impact on the risk of 2-year change in photographic breast appearance after hypofractionated breast radiotherapy than after standard fractionation.Ó 2012 Elsevier Ireland Ltd. All rights reserved. Radiotherapy and Oncology 104 (2012) 143-147The routine use of hypofractionation in breast radiotherapy is supported by outcome data of four large randomised clinical trials in women with early breast cancer [1][2][3][4][5][6][7]. Residual concerns include the impact of dose inhomogeneity on the risk of adverse effects after hypofractionated schedules, so-called 'treble trouble' [8][9][10]. A causal association between breast dose inhomogeneity and the risk of late tissue complications is suggested by the 5 years follow up results of a UK randomised trial (N = 306) comparing 2D versus 3D breast dosimetry [11]. Assuming dose distribution matters, it is not known if residual dose inhomogeneity in patients treated using 3D dose compensation contributes to a higher risk of adverse effects after hypofractionated radiotherapy than after standard regimens. Against this background, a retrospective analysis of a UK hypofractionation trial, which recently published its 2 years follow-up results [12], has been undertaken to test the hypothesis that residual dose inhomogeneity has a greater impact on late adverse effect in women prescribed hypofractionated whole breast radiotherapy, even when delivered in conformity with the International Commission on Radiation Units...

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“…While the use of simple Intensity Modulated Radiation Therapy (IMRT) planning techniques improves dose homogeneity within the breast tissue,5, 6 they are currently more labor intensive, requiring greater planning expertise and longer planning times than wedge only compensation 7. In addition to this, the development of more complex treatment techniques for breast cancer patients, such as those incorporating simultaneous integrated boosts or internal mammary lymph node irradiation,8 will lead to a significant workload increase in terms of critical structure delineation.…”

Section: Introductionmentioning

confidence: 99%

Improving the efficiency of breast radiotherapy treatment planning using a semi‐automated approach

Mitchell

Wai

Colgan

et al. 2016

J Applied Clin Med Phys

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ObjectivesTo reduce treatment planning times while maintaining plan quality through the introduction of semi‐automated planning techniques for breast radiotherapy.MethodsAutomatic critical structure delineation was examined using the Smart Probabilistic Image Contouring Engine (SPICE) commercial autosegmentation software (Philips Radiation Oncology Systems, Fitchburg, WI) for a cohort of ten patients. Semiautomated planning was investigated by employing scripting in the treatment planning system to automate segment creation for breast step‐and‐shoot planning and create objectives for segment weight optimization; considerations were made for three different multileaf collimator (MLC) configurations. Forty patients were retrospectively planned using the script and a planning time comparison performed.ResultsThe SPICE heart and lung outlines agreed closely with clinician‐defined outlines (median Dice Similarity Coefficient > 0.9); median difference in mean heart dose was 0.0 cGy (range −10.8 to 5.4 cGy). Scripted treatment plans demonstrated equivalence with their clinical counterparts. No statistically significant differences were found for target parameters. Minimal ipsilateral lung dose increases were also observed. Statistically significant (P < 0.01) time reductions were achievable for MLCi and Agility MLC (Elekta Ltd, Crawley, UK) plans (median 4.9 and 5.9 min, respectively).ConclusionsThe use of commercial autosegmentation software enables breast plan adjustment based on doses to organs at risk. Semi‐automated techniques for breast radiotherapy planning offer modest reductions in planning times. However, in the context of a typical department's breast radiotherapy workload, minor savings per plan translate into greater efficiencies overall.

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Randomised trial of standard 2D radiotherapy (RT) versus intensity modulated radiotherapy (IMRT) in patients prescribed breast radiotherapy

Cited by 436 publications

References 28 publications

Acute Toxicity and 2-year Adverse Effects of 30 Gy in Five Fractions over 15 Days to Whole Breast after Local Excision of Early Breast Cancer

Acute Toxicity and 2-year Adverse Effects of 30 Gy in Five Fractions over 15 Days to Whole Breast after Local Excision of Early Breast Cancer

The impact of dose heterogeneity on late normal tissue complication risk after hypofractionated whole breast radiotherapy

Improving the efficiency of breast radiotherapy treatment planning using a semi‐automated approach

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