title: Prospective Randomized Trial of Prone Accelerated Intensity Modulated Breast Radiation Therapy With a Daily Versus Weekly Boost to the Tumor Bed.
abstract: To report the results of a prospective randomized trial comparing a daily versus weekly boost to the tumor cavity during the course of accelerated radiation to the breast with patients in the prone position.
  
  
  
  From 2009 to 2012, 400 patients with stage 0 to II breast cancer who had undergone segmental mastectomy participated in an institutional review board-approved trial testing prone breast radiation therapy to 40.5 Gy in 15 fractions 5 d/wk to the whole breast, after randomization to a concomitant daily boost to the tumor bed of 0.5 Gy, or a weekly boost of 2 Gy, on Friday. The present noninferiority trial tested the primary hypothesis that a weekly boost produced no more acute toxicity than did a daily boost. The recurrence-free survival was estimated for both treatment arms using the Kaplan-Meier method; the relative risk of recurrence or death was estimated, and the 2 arms were compared using the log-rank test.
  
  
  
  At a median follow-up period of 45 months, no deaths related to breast cancer had occurred. The weekly boost regimen produced no more grade ≥2 acute toxicity than did the daily boost regimen (8.1% vs 10.4%; noninferiority Z = -2.52; P=.006). No statistically significant difference was found in the cumulative incidence of long-term fibrosis or telangiectasia of grade ≥2 between the 2 arms (log-rank P=.923). Two local and two distant recurrences developed in the daily treatment arm and three local and one distant developed in the weekly arm. The 4-year recurrence-free survival rate was not different between the 2 treatment arms (98% for both arms).
  
  
  
  A tumor bed boost delivered either daily or weekly was tolerated similarly during accelerated prone breast radiation therapy, with excellent control of disease and comparable cosmetic results.
authors.affiliation: Department of Radiation Oncology, New York University School of Medicine and Langone Medical Center, New York, New York.
authors.forename: Benjamin T
authors.initials: BT
authors.lastname: Cooper
authors.affiliation: Department of Radiation Oncology, New York University School of Medicine and Langone Medical Center, New York, New York.
authors.forename: George F
authors.initials: GF
authors.lastname: Formenti-Ujlaki
authors.affiliation: Division of Biostatistics, Departments of Population Health and Environmental Medicine, New York University School of Medicine, New York, New York.
authors.forename: Xiaochun
authors.initials: X
authors.lastname: Li
authors.affiliation: Department of Radiation Oncology, New York University School of Medicine and Langone Medical Center, New York, New York.
authors.forename: Samuel M
authors.initials: SM
authors.lastname: Shin
authors.affiliation: Department of Radiation Oncology, New York University School of Medicine and Langone Medical Center, New York, New York.
authors.forename: Maria
authors.initials: M
authors.lastname: Fenton-Kerimian
authors.affiliation: Department of Surgery, New York University School of Medicine and Langone Medical Center, New York, New York.
authors.forename: Amber
authors.initials: A
authors.lastname: Guth
authors.affiliation: Department of Surgery, New York University School of Medicine and Langone Medical Center, New York, New York.
authors.forename: Daniel F
authors.initials: DF
authors.lastname: Roses
authors.affiliation: Department of Radiation Oncology, New York University School of Medicine and Langone Medical Center, New York, New York.
authors.forename: Christine J
authors.initials: CJ
authors.lastname: Hitchen
authors.affiliation: Department of Radiation Oncology, New York University School of Medicine and Langone Medical Center, New York, New York; Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, New York.
authors.forename: Barry S
authors.initials: BS
authors.lastname: Rosenstein
authors.affiliation: Department of Radiation Oncology, New York University School of Medicine and Langone Medical Center, New York, New York.
authors.forename: J Keith
authors.initials: JK
authors.lastname: Dewyngaert
authors.affiliation: Division of Biostatistics, Departments of Population Health and Environmental Medicine, New York University School of Medicine, New York, New York.
authors.forename: Judith D
authors.initials: JD
authors.lastname: Goldberg
authors.affiliation: Department of Radiation Oncology, New York University School of Medicine and Langone Medical Center, New York, New York. Electronic address: formenti@med.cornell.edu.
authors.forename: Silvia C
authors.initials: SC
authors.lastname: Formenti
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000401:mortality / Q000532:radiotherapy*; D019583:Dose Fractionation, Radiation; D005260:Female; D006801:Humans; D008875:Middle Aged; D016684:Prone Position; D011446:Prospective Studies; D050397:Radiotherapy, Intensity-Modulated / Q000009:adverse effects / Q000379:methods*