title: Randomized controlled trial of forward-planned intensity modulated radiotherapy for early breast cancer: interim results at 2 years.
abstract: OBJECTIVE
  This single-center randomized trial was designed to investigate whether intensity-modulated radiotherapy (IMRT) reduces late toxicity in patients with early-stage breast cancer.
  
  
  METHODS
  The standard tangential plans of 1,145 nonselected patients were analyzed. The patients with inhomogeneous plans were randomized to a simple method of forward-planned IMRT or standard radiotherapy (RT). The primary endpoint was serial photographic assessment of breast shrinkage.
  
  
  RESULTS
  At 2 years, no significant difference was found in the development of any photographically assessed breast shrinkage between the patients randomized to the interventional or control group (odds ratio, 1.51; 95% confidence interval, 0.83-1.58; p = .41). The patients in the control group were more likely to develop telangiectasia than those in the IMRT group (odds ratio, 1.68; 95% confidence interval 1.13-2.40; p = .009). Poor baseline surgical cosmesis resulted in poor overall cosmesis at 2 years after RT. In patients who had good surgical cosmesis, those randomized to IMRT were less likely to deteriorate to a moderate or poor overall cosmesis than those in the control group (odds ratio, 0.63; 95% confidence interval, 0.39-1.03, p = .061).
  
  
  CONCLUSIONS
  IMRT can lead to a significant reduction in telangiectasia at comparatively early follow-up of only 2 years after RT completion. An important component of breast induration and shrinkage will actually result from the surgery and not from the RT. Surgical cosmesis is an important determinant of overall cosmesis and could partially mask the longer term benefits of IMRT at this early stage.
authors.affiliation: Department of Oncology, University of Cambridge, Cambridge University Hospitals, National Health Service Foundation Trust, Cambridge, United Kingdom.
authors.forename: Gillian C
authors.initials: GC
authors.lastname: Barnett
authors.forename: Jennifer S
authors.initials: JS
authors.lastname: Wilkinson
authors.forename: Anne M
authors.initials: AM
authors.lastname: Moody
authors.forename: Charles B
authors.initials: CB
authors.lastname: Wilson
authors.forename: Nicola
authors.initials: N
authors.lastname: Twyman
authors.forename: Gordon C
authors.initials: GC
authors.lastname: Wishart
authors.forename: Neil G
authors.initials: NG
authors.lastname: Burnet
authors.forename: Charlotte E
authors.initials: CE
authors.lastname: Coles
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D001940:Breast / Q000473:pathology / Q000528:radiation effects; D001941:Breast Diseases / Q000209:etiology; D001943:Breast Neoplasms / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D016001:Confidence Intervals; D004954:Esthetics; D005260:Female; D006801:Humans; D008488:Medical Illustration; D008875:Middle Aged; D009367:Neoplasm Staging; D016017:Odds Ratio; D009929:Organ Size / Q000528:radiation effects; D010781:Photography; D011880:Radiotherapy Planning, Computer-Assisted / Q000379:methods*; D050397:Radiotherapy, Intensity-Modulated / Q000379:methods*; D013684:Telangiectasis / Q000209:etiology; D047368:Tumor Burden / Q000528:radiation effects*