Breast intensity-modulated radiation therapy reduces time spent with acute dermatitis for women of all breast sizes during radiation.
OBJECTIVE
To study the time spent with radiation-induced dermatitis during a course of radiation therapy for breast cancer in women treated with conventional or intensity-modulated radiation therapy (IMRT).


METHODS
The study population consisted of 804 consecutive women with early-stage breast cancer treated with breast-conserving surgery and radiation from 2001 to 2006. All patients were treated with whole-breast radiation followed by a boost to the tumor bed. Whole-breast radiation consisted of conventional wedged photon tangents (n = 405) earlier in the study period and mostly of photon IMRT (n = 399) in later years. All patients had acute dermatitis graded each week of treatment.


RESULTS
The breakdown of the cases of maximum acute dermatitis by grade was as follows: 3%, Grade 0; 34%, Grade 1; 61%, Grade 2; and 2%, Grade 3. The breakdown of cases of maximum toxicity by technique was as follows: 48%, Grade 0/1, and 52%, Grade 2/3, for IMRT; and 25%, Grade 0/1, and 75%, Grade 2/3, for conventional radiation therapy (p < 0.0001). The IMRT patients spent 82% of weeks during treatment with Grade 0/1 dermatitis and 18% with Grade 2/3 dermatitis, compared with 29% and 71% of patients, respectively, treated with conventional radiation (p < 0.0001). Furthermore, the time spent with Grade 2/3 toxicity was decreased in IMRT patients with small (p = 0.0015), medium (p < 0.0001), and large (p < 0.0001) breasts.


CONCLUSIONS
Breast IMRT is associated with a significant decrease both in the time spent during treatment with Grade 2/3 dermatitis and in the maximum severity of dermatitis compared with that associated with conventional radiation, regardless of breast size.
Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, PA 19111, USA. Gary.Freedman@FCCC.edu
Gary M
GM
Freedman
Tianyu
T
Li
Nicos
N
Nicolaou
Yan
Y
Chen
Charlie C-M
CC
Ma
Penny R
PR
Anderson
D000208:Acute Disease; D000970:Antineoplastic Agents / Q000009:adverse effects; D001940:Breast / Q000033:anatomy & histology*; D001943:Breast Neoplasms / Q000188:drug therapy / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D005260:Female; D006801:Humans; D015412:Mastectomy, Segmental; D009929:Organ Size; D017785:Photons / Q000627:therapeutic use; D011855:Radiodermatitis / Q000473:pathology*; D011879:Radiotherapy Dosage; D050397:Radiotherapy, Intensity-Modulated / Q000009:adverse effects / Q000379:methods; D012189:Retrospective Studies; D013997:Time Factors
D000970:Antineoplastic Agents