A multicenter randomized trial of breast intensity-modulated radiation therapy to reduce acute radiation dermatitis.
OBJECTIVE
Dermatitis is a frequent adverse effect of adjuvant breast radiotherapy. It is more likely in full-breasted women and when the radiation is distributed nonhomogeneously in the breast. Breast intensity-modulated radiation therapy (IMRT) is a technique that ensures a more homogeneous dose distribution.


METHODS
A multicenter, double-blind, randomized clinical trial was performed to test if breast IMRT would reduce the rate of acute skin reaction (notably moist desquamation), decrease pain, and improve quality of life compared with standard radiotherapy using wedges. Patients were assessed each week during and up to 6 weeks after radiotherapy.


RESULTS
A total of 358 patients were randomly assigned between July 2003 and March 2005 in two Canadian centers, and 331 were included in the analysis. Breast IMRT significantly improved the dose distribution compared with standard radiation. This translated into a lower proportion of patients experiencing moist desquamation during or up to 6 weeks after their radiation treatment; 31.2% with IMRT compared with 47.8% with standard treatment (P = .002). A multivariate analysis found the use of breast IMRT (P = .003) and smaller breast size (P < .001) were significantly associated with a decreased risk of moist desquamation. The use of IMRT did not correlate with pain and quality of life, but the presence of moist desquamation did significantly correlate with pain (P = .002) and a reduced quality of life (P = .003).


CONCLUSIONS
Breast IMRT significantly reduced the occurrence of moist desquamation compared with a standard wedged technique. Moist desquamation was correlated with increased pain and reduction in the quality of life.
Pignol
Jean-Philippe
JP
Department of Radiation Oncology, Sunnybrook Health Sciences Centre T2-144, 2075, Bayview Ave, Toronto, Ontario, M4N 3M5 Canada. Jean-Philippe.Pignol@sunnybrook.ca
Olivotto
Ivo
I
Rakovitch
Eileen
E
Gardner
Sandra
S
Sixel
Katharina
K
Beckham
Wayne
W
Vu
Thi Trinh Thuc
TT
Truong
Pauline
P
Ackerman
Ida
I
Paszat
Lawrence
L
D000208:Acute Disease; D000368:Aged; D001940:Breast / Q000473:pathology; D001943:Breast Neoplasms / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D002170:Canada; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D016015:Logistic Models; D015412:Mastectomy, Segmental; D008875:Middle Aged; D009367:Neoplasm Staging; D010146:Pain / Q000209:etiology / Q000517:prevention & control; D010147:Pain Measurement; D011788:Quality of Life; D011829:Radiation Dosage; D011855:Radiodermatitis / Q000209:etiology / Q000517:prevention & control*; D018714:Radiotherapy, Adjuvant / Q000009:adverse effects; D050397:Radiotherapy, Intensity-Modulated / Q000009:adverse effects; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome