title: Reduction in radiation-induced morbidity by use of an intercurrent boost in the management of early-stage breast cancer.
abstract: OBJECTIVE
  Electron or photon boost immediately following whole-breast irradiation performed after conservation surgery for early-stage breast cancer is the accepted standard of care. This regimen frequently results in Grade III dermatitis, causing discomfort or treatment interruption. Herein, we compare patients treated with whole-breast irradiation followed by boost compared with a cohort with a planned intercurrent radiation boost.
  
  
  METHODS
  The records of 650 consecutive breast cancer patients treated at Allegheny General Hospital (AGH) between 2000 and 2008 were reviewed. Selected for this study were 327 patients with T1 or T2 tumors treated with external beam radiotherapy postlumpectomy. One hundred and sixty-nine patients were treated by whole-breast radiotherapy (WBRT) followed by boost at completion. One hundred fifty-eight were treated with a planned intercurrent boost (delivered following 3,600 cGy WBRT). The mean whole breast radiation dose in the conventionally treated group was 5,032 cGy (range, 4500-5400 cGy), and the mean whole breast dose was 5,097 cGy (range, 4860-5040 cGy) in the group treated with a planned intercurrent boost.
  
  
  RESULTS
  The occurrence of Grade III dermatitis was significantly reduced in the WBRT/intercurrent boost group compared with the WBRT/boost group (0.6% vs. 8.9%), as was the incidence of treatment interruption (1.9% vs. 14.2%). With a median follow-up of 32 months and 27 months, respectively, no significant difference in local control was identified.
  
  
  CONCLUSIONS
  Patients treated with intercurrent boost developed less Grade III dermatitis and unplanned treatment interruptions with similar local control.
authors.affiliation: Department of Radiation Oncology, Allegheny General Hospital, Pittsburgh, PA 15212, USA. mtrombet@wpahs.org
authors.forename: Mark
authors.initials: M
authors.lastname: Trombetta
authors.forename: Thomas B
authors.initials: TB
authors.lastname: Julian
authors.forename: Vladimir
authors.initials: V
authors.lastname: Valakh
authors.forename: Larisa
authors.initials: L
authors.lastname: Greenberg
authors.forename: George
authors.initials: G
authors.lastname: Labban
authors.forename: Mian K
authors.initials: MK
authors.lastname: Khalid
authors.forename: E Day
authors.initials: ED
authors.lastname: Werts
authors.forename: David
authors.initials: D
authors.lastname: Parda
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D003131:Combined Modality Therapy / Q000379:methods; D004583:Electrons / Q000627:therapeutic use; D005260:Female; D006801:Humans; D015412:Mastectomy, Segmental; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D017785:Photons / Q000627:therapeutic use; D011855:Radiodermatitis / Q000517:prevention & control*; D011878:Radiotherapy / Q000379:methods; D011879:Radiotherapy Dosage; D012189:Retrospective Studies