Prospective Randomized Trial of Prone Accelerated Intensity Modulated Breast Radiotherapy with a Daily versus Weekly Boost to the Tumor Bed

Publication date: Available online 29 December 2015
Source:International Journal of Radiation Oncology*Biology*Physics
Author(s): B.T. Cooper, G.F. Formenti-Ujlaki, X. Li, S.M. Shin, M. Fenton-Kerimian, A. Guth, D.F. Roses, C.J. Hitchen, B.S. Rosenstein, J.K. Dewyngaert, J.D. Goldberg, S.C. Formenti
PurposeTo report the results of a prospective randomized trial comparing a daily versus weekly boost to the tumor cavity during the course of accelerated radiation to the breast in the prone position.Methods and MaterialsFrom 2009-2012, 400 stage 0-II breast cancer patients who had undergone segmental mastectomy participated in an IRB-approved trial testing prone breast radiotherapy to 40.5 Gy/15 fractions to the whole breast, five days a week after randomization to a concomitant daily boost to the tumor bed of 0.5 Gy, or a weekly boost of 2 Gy, on Friday. This non-inferiority trial tested the primary hypothesis that a weekly boost produced no more acute toxicity than a daily boost. Recurrence Free Survival (RFS) was estimated for both treatment arms using the Kaplan-Meier method; the relative risk of recurrence or death was estimated and the two arms were compared with the log-rank test.ResultsAt a median follow-up of 45 months, there were no deaths related to breast cancer. The weekly boost regimen produced no more grade ≥ 2 acute toxicity than the daily boost regimen (8.1% vs 10.4%; non-inferiority Z = -2.52; p = 0.006). There was no statistical difference in cumulative incidences of long term fibrosis or telangiectasia ≥2 between the two arms (log-rank p=0.923). There were 2 local and 2 distant recurrences in the daily arm. There were 3 local and 1 distant recurrences in the weekly arm, with no difference in 4-year RFS between the two arms (98% in both arms).ConclusionsA tumor bed boost delivered either daily or weekly is similarly tolerated during accelerated prone breast radiotherapy, with excellent control of disease and comparable cosmetic results.

Teaser

We conducted a prospective trial randomizing women with early stage breast cancer to accelerated prone, whole breast radiotherapy with a weekly versus daily boost to the tumor bed. At a median follow-up of 45 months, there was no difference in toxicity or efficacy between the two treatment arms. There was a trend towards more patients reporting good/excellent cosmesis among those treated with the weekly boost.


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