Abstract
Background and purpose
This large trial was designed to investigate whether correction of dose inhomogeneities
using intensity-modulated radiotherapy (IMRT) reduces late toxicity and improves quality
of life in patients with early breast cancer. This paper reports baseline characteristics
of trial participants and dosimetry results.
Materials and methods
Standard tangential plans of 1145 trials were analysed. Patients with inhomogeneous
plans, defined by ICRU recommendations, were randomised to forward-planned IMRT or
standard radiotherapy.
Results
Twenty-nine percentage of patients had adequate dosimetry with standard 2D radiotherapy.
In the randomised patients, the decreases in mean volumes receiving greater than 107%
(Vol > 107) and less than 95% (Vol < 95) of the prescribed dose in the IMRT compared with the control group were 34.0 cm3 (95% CI 26.4–41.6; P < 0.0001) and 48.1 cm3 (95% CI 34.4–61.9; P < 0.0001), respectively. In this study, 90% of patients who had a breast separation
greater ⩾21 cm had Vol > 107 > 2 cm3 on standard radiotherapy plans.
Conclusion
This large trial, in which patients with all breast sizes were eligible, confirmed
that breast dosimetry can be significantly improved with a simple method of forward-planned
IMRT and has little impact on radiotherapy resources. It is shown that patients with
larger breasts are more likely to have dose inhomogeneities and breast separation
gives some indication of this likelihood. Photographic assessment of patients at 2 years after radiotherapy, as the next part of this randomised controlled trial, will
show whether these results for IMRT translate into improved cosmetic outcome in patients
with early breast cancer. This would provide impetus for the widespread adoption of
3D planning and IMRT.
Keywords
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Article info
Publication history
Published online: April 20, 2009
Accepted:
March 4,
2009
Received in revised form:
March 3,
2009
Received:
October 20,
2008
Identification
Copyright
© 2009 Elsevier Ireland Ltd. Published by Elsevier Inc. All rights reserved.
