title: Randomized controlled trial of intensity-modulated radiotherapy for early breast cancer: 5-year results confirm superior overall cosmesis.
abstract: OBJECTIVE
  There are few randomized controlled trial data to confirm that improved homogeneity with simple intensity-modulated radiotherapy (IMRT) decreases late breast tissue toxicity. The Cambridge Breast IMRT trial investigated this hypothesis, and the 5-year results are reported.
  
  
  METHODS
  Standard tangential plans of 1,145 trial patients were analyzed; 815 patients had inhomogeneous plans (≥ 2 cm(3) receiving 107% of prescribed dose: 40 Gy in 15 fractions over 3 weeks) and were randomly assigned to standard radiotherapy (RT) or replanned with simple IMRT; 330 patients with satisfactory dose homogeneity were treated with standard RT and underwent the same follow-up as the randomly assigned patients. Breast tissue toxicities were assessed at 5 years using validated methods: photographic assessment (overall cosmesis and breast shrinkage compared with baseline pre-RT photographs) and clinical assessment (telangiectasia, induration, edema, and pigmentation). Comparisons between different groups were analyzed using polychotomous logistic regression.
  
  
  RESULTS
  On univariate analysis, compared with standard RT, fewer patients in the simple IMRT group developed suboptimal overall cosmesis (odds ratio [OR], 0.68; 95% CI, 0.48 to 0.96; P = .027) and skin telangiectasia (OR, 0.58; 95% CI, 0.36 to 0.92; P = .021). No evidence of difference was seen for breast shrinkage, breast edema, tumor bed induration, or pigmentation. The benefit of IMRT was maintained on multivariate analysis for both overall cosmesis (P = .038) and skin telangiectasia (P = .031).
  
  
  CONCLUSIONS
  Improved dose homogeneity with simple IMRT translates into superior overall cosmesis and reduces the risk of skin telangiectasia. These results are practice changing and should encourage centers still using two-dimensional RT to implement simple breast IMRT.
authors.affiliation: Mukesh B. Mukesh, Gillian C. Barnett, Jennifer S. Wilkinson, Anne M. Moody, Charles Wilson, Wendi Qian, Nicola Twyman, Neil G. Burnet, and Charlotte E. Coles, Cambridge University Hospitals National Health Service Foundation Trust; Gillian C. Barnett, Charleen Chan Wah Hak, and Neil G. Burnet, University of Cambridge; and Gordon C. Wishart, Anglia Ruskin University, Cambridge, United Kingdom.
authors.forename: Mukesh B
authors.initials: MB
authors.lastname: Mukesh
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
authors.initials: C
authors.lastname: Wilson
authors.forename: Leila
authors.initials: L
authors.lastname: Dorling
authors.forename: Charleen
authors.initials: C
authors.lastname: Chan Wah Hak
authors.forename: Wendi
authors.initials: W
authors.lastname: Qian
authors.forename: Nicola
authors.initials: N
authors.lastname: Twyman
authors.forename: Neil G
authors.initials: NG
authors.lastname: Burnet
authors.forename: Gordon C
authors.initials: GC
authors.lastname: Wishart
authors.forename: Charlotte E
authors.initials: CE
authors.lastname: Coles
mesh_terms: D000328:Adult; D000368:Aged; D001504:Beauty; D001943:Breast Neoplasms / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D004487:Edema / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016015:Logistic Models; D015412:Mastectomy, Segmental; D008875:Middle Aged; D009367:Neoplasm Staging; D016017:Odds Ratio; D017060:Patient Satisfaction; D010781:Photography; D010859:Pigmentation Disorders / Q000209:etiology; D011879:Radiotherapy Dosage; D011880:Radiotherapy Planning, Computer-Assisted; D018714:Radiotherapy, Adjuvant; D050397:Radiotherapy, Intensity-Modulated / Q000009:adverse effects / Q000379:methods; D013684:Telangiectasis / Q000209:etiology; D016896:Treatment Outcome