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IMRT reduced radiation skin burn in women with breast cancer
Improved radiation delivery reduced the development of moist desquamation compared with standard wedge compensation.
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Women who receive intensity modulated radiation therapy as part of their breast cancer treatment are three times less likely to experience severe skin reactions compared with those receiving standard wedge radiation therapy. The promising data were presented at the 48th Annual Meeting of the American Society for Therapeutic Radiology and Oncology.
“Using IMRT, we are able to dramatically reduce the painful side effects of radiation, thereby improving the patient’s quality of life,” said Jean-Philippe Pignol, MD, PhD, lead author of the study and a radiation oncologist at Sunnybrook Health Sciences Centre in Toronto, Canada. “Patients should be aware that breast IMRT has fewer side effects than standard radiation therapy and is now widely available.”
Comparing techniques
The current standard of care for breast cancer is surgery followed by radiation. Physicians conventionally deliver radiation via two opposite beams aimed at the breast. However this technique can deposit excess radiation to certain areas of the breast, increasing the risk of developing moist desquamation: sensitive, red, weepy skin that may blister and peel. Most (80%) severe skin burns occur on the breast crease, located between the bottom of the breast and the chest wall.
Using IMRT, however, radiation oncologists are able to control the intensity of each beam to minimize toxicity to nearby healthy tissue, thereby minimizing the risk of too much radiation on a part of the breast leading to severe skin reactions. Although several studies have suggested this benefit, there have been no randomized trials to prove it.
Study design
Pignol and colleagues evaluated 358 patients who were randomly assigned to either wedge compensation or IMRT. Patients were observed for six weeks after treatment. Their objective, phase-3 study evaluated how much IMRT could reduce acute skin toxicity compared with wedge compensation. The primary endpoints were the rates of grade-3 to -4 acute skin reaction and grade-2 to -4 moist desquamation as defined by the NCI Common Toxicity Grading scale.
Researchers randomized the women to receive either radiation method at doses up to 50 Gy, with or without a 16 Gy boost. Randomization was stratified by breast size and boost delivery. Patients were assessed for skin toxicity weekly during the treatment.
Results
Among 331 evaluable patients, IMRT improved dose distribution homogeneity, particularly to the breast crease (P<.0001). Breast IMRT, compared with wedge compensation, reduced moist desquamation in all breast quadrants (31% vs. 48%; P=.0019) and in the inframammary fold (26% vs. 43%; P=.0012). Toxicity was similar, as IMRT did not significantly reduce the maximum toxicity (grade-2 or -4) in all quadrants, compared with wedge compensation (P=.29), according to Pignol and colleagues.
The use of IMRT reduced inframammary fold grade-2 to -4 skin toxicity (OR=.262, P<.001, 95% CI, 0.135-0.503), researchers reported. The study also confirmed that breast volume was the only significant factor associated with increased acute skin toxicity.
For more information:
- Pignol K, Olivotto I, Rakovitch E, et al. Phase III randomized study of intensity modulated radiation therapy vs. standard wedging adjuvant breast radiotherapy. Plenary 1. Presented at: 48th Annual Meeting of the American Society for Therapeutic Radiology and Oncology; November 5-9, 2006; Philadelphia.