Impact of the boost dose of 10Gy versus 26Gy in patients with early stage breast cancer after a microscopically incomplete lumpectomy: 10-year results of the randomised EORTC boost trial

Abstract 

Purpose

To assess the impact of the boost dose in patients with involved surgical margins.

Patients and methods

In the EORTC “boost versus no boost” trial, 251 patients with a microscopically incomplete tumour excision were randomised to receive either a low boost dose of 10Gy (126 patients) or a high boost dose of 26Gy (125 patients). Overall survival and the cumulative incidence of local recurrence as first event were compared by Logrank and Gray test, respectively (2-sided α=0.05), with a median follow-up of 11.3 years. The planned sample size was 660 patients, but only 251 were recruited.

Results

The median age at randomisation was 54 years. Thirty-seven patient initially relapsed locally. At 10 years, the cumulative incidence of local recurrence was 17.5% (95% CI: 10.4–24.6%) versus 10.8% (95% CI: 5.2–16.4%) for the low and high boost dose groups, respectively (HR=0.83, 95% CI: 0.43–1.57, Gray p>0.1). Overall, 64 patients have died (25.5%), 47 of them of breast cancer, without a difference in duration of survival between the two groups (HR=0.97, 95% CI=0.59–1.5, p>0.1). Severe fibrosis was palpated in the breast in 1% versus 5% and in the boost area in 3% versus 13% in the low and high boost dose groups, respectively.

Conclusions

There was no statistically significant difference in local control or survival between the high boost dose of 26Gy and the low boost dose of 10Gy in patients with microscopically incomplete excision of early breast cancer. Fibrosis, however, was noted significantly more frequently in cases treated with the high boost dose.

Keywords: Randomised clinical trial, Breast cancer, Radiotherapy, Breast-conserving therapy, Incomplete resection, Boost