title: Use of intensity modulated radiation therapy to reduce acute and chronic toxicities of breast cancer patients treated with traditional and accelerated whole breast irradiation.
abstract: OBJECTIVE
  The purpose of this analysis was to examine the impact of applying intensity modulated radiation therapy (IMRT) on toxicity with traditional and accelerated whole breast irradiation (AWBI).
  
  
  METHODS
  A total of 335 patients with stage 0-IIB breast cancer were treated with either a conventional wedge technique (S-WBI, n = 87), IMRT (I-WBI, n = 93), or AWBI with IMRT (I-AWBI, n = 155). S-WBI and I-WBI patients received a median dose of 45 Gy to the breast with a median 16-Gy tumor bed boost for a cumulative median dose of 61 Gy. I-AWBI patients received a median dose of 42.56 Gy via an accelerated IMRT plan, without a boost. Acute and chronic toxicities were assessed using Common Toxicity Criteria v.3.0.
  
  
  RESULTS
  Median follow-up was 11.0, 9.1, and 1.1 years for S-WBI, I-WBI, and I-AWBI patients, respectively. When comparing patients of all breast sizes, I-WBI showed decreased incidences of grade 2+ acute radiation dermatitis and induration compared with I-AWBI (1% vs 23%, P < .001/0% vs 5%; P = .05 ) and S-WBI (1% vs 12%, P = .007/0% vs 6%; P = .02). I-WBI also had lower rates of chronic edema compared with S-WBI patients (3% vs 13%, P = .03). In larger breasted patients, I-WBI was associated with reduced acute toxicities compared with S-WBI with regard to grade 2 + dermatitis and edema (0% vs 19%, P = .02/7% vs 24%, P = .06). No differences were seen between I-WBI and I-AWBI with IMRT techniques with the exception of increased acute radiation dermatitis in I-AWBI patients (0% vs 38%, P < .001).
  
  
  CONCLUSIONS
  This analysis confirms previous data which have demonstrated that RT with IMRT is associated with reduced toxicities compared with conventional techniques. In larger breasted women, with the exception of acute skin reactions, I-AWBI showed comparable rates of toxicities compared with I-WBI. These data support the use of IMRT to expand the role of AWBI and the currently accruing Radiation Therapy Oncology Group 1005 trial.
authors.affiliation: Department of Radiation Oncology, Beaumont Cancer Institute, Oakland University William Beaumont School of Medicine, Royal Oak, Michigan.
authors.forename: Chirag
authors.initials: C
authors.lastname: Shah
authors.affiliation: Department of Radiation Oncology, Beaumont Cancer Institute, Oakland University William Beaumont School of Medicine, Royal Oak, Michigan.
authors.forename: Jessica
authors.initials: J
authors.lastname: Wobb
authors.affiliation: Department of Radiation Oncology, Beaumont Cancer Institute, Oakland University William Beaumont School of Medicine, Royal Oak, Michigan.
authors.forename: Inga
authors.initials: I
authors.lastname: Grills
authors.affiliation: Department of Radiation Oncology, Beaumont Cancer Institute, Oakland University William Beaumont School of Medicine, Royal Oak, Michigan.
authors.forename: Michelle
authors.initials: M
authors.lastname: Wallace
authors.affiliation: Department of Radiation Oncology, Beaumont Cancer Institute, Oakland University William Beaumont School of Medicine, Royal Oak, Michigan.
authors.forename: Christina
authors.initials: C
authors.lastname: Mitchell
authors.affiliation: Michigan Healthcare Professionals, 21st Century Oncology, Farmington Hills, Michigan. Electronic address: favicini@botsford.org.
authors.forename: Frank A
authors.initials: FA
authors.lastname: Vicini