Pignol JP, Olivotto I, Rakovitch E, Gardner S, Sixel K, Beckham W, Vu TT, Truong P, Ackerman I, Paszat L, et al.
Journal of clinical oncology : official journal of the American Society of Clinical Oncology. Date of publication 2008 May 1;volume 26(13):2085-92.
1. J Clin Oncol. 2008 May 1;26(13):2085-92. doi: 10.1200/JCO.2007.15.2488. Epub 2008
Feb 19.
A multicenter randomized trial of breast intensity-modulated radiation therapy to
reduce acute radiation dermatitis.
Pignol JP(1), Olivotto I, Rakovitch E, Gardner S, Sixel K, Beckham W, Vu TT,
Truong P, Ackerman I, Paszat L.
Author information:
(1)Department of Radiation Oncology, Sunnybrook Health Sciences Centre T2-144,
2075, Bayview Ave, Toronto, Ontario, M4N 3M5 Canada.
Jean-Philippe.Pignol@sunnybrook.ca
Comment in
J Clin Oncol. 2008 May 1;26(13):2072-4.
J Clin Oncol. 2008 Jul 1;26(19):3292; author reply 3292-3.
J Clin Oncol. 2008 Nov 10;26(32):5305-6; author reply 5306.
PURPOSE: Dermatitis is a frequent adverse effect of adjuvant breast radiotherapy.
It is more likely in full-breasted women and when the radiation is distributed
nonhomogeneously in the breast. Breast intensity-modulated radiation therapy
(IMRT) is a technique that ensures a more homogeneous dose distribution.
PATIENTS AND METHODS: A multicenter, double-blind, randomized clinical trial was
performed to test if breast IMRT would reduce the rate of acute skin reaction
(notably moist desquamation), decrease pain, and improve quality of life compared
with standard radiotherapy using wedges. Patients were assessed each week during
and up to 6 weeks after radiotherapy.
RESULTS: A total of 358 patients were randomly assigned between July 2003 and
March 2005 in two Canadian centers, and 331 were included in the analysis. Breast
IMRT significantly improved the dose distribution compared with standard
radiation. This translated into a lower proportion of patients experiencing moist
desquamation during or up to 6 weeks after their radiation treatment; 31.2% with
IMRT compared with 47.8% with standard treatment (P = .002). A multivariate
analysis found the use of breast IMRT (P = .003) and smaller breast size (P <
.001) were significantly associated with a decreased risk of moist desquamation.
The use of IMRT did not correlate with pain and quality of life, but the presence
of moist desquamation did significantly correlate with pain (P = .002) and a
reduced quality of life (P = .003).
CONCLUSION: Breast IMRT significantly reduced the occurrence of moist
desquamation compared with a standard wedged technique. Moist desquamation was
correlated with increased pain and reduction in the quality of life.
DOI: 10.1200/JCO.2007.15.2488
PMID: 18285602 [Indexed for MEDLINE]
