Skin Toxicity in Early Breast Cancer Patients Treated with Field-In-Field Breast Intensity-Modulated Radiotherapy...

Area of Science:

• Radiation Oncology
• Medical Physics
• Oncology

Background:

• Skin toxicity is a frequent side effect of breast radiotherapy.
• Intensity-modulated radiotherapy (IMRT) techniques aim to improve dose distribution and reduce toxicity.

Purpose of the Study:

• To compare the incidence of skin toxicity between inverse-planned helical tomotherapy IMRT (HT-IMRT) and forward field-in-field IMRT (FiF-IMRT) in early-stage breast cancer patients.

Main Methods:

• A phase III randomized controlled trial involving 177 patients undergoing whole-breast irradiation.
• Comparison of skin toxicity (erythema, moist desquamation) as the primary endpoint between FiF-IMRT and HT-IMRT arms.
• Median follow-up of 73.1 months with assessment of acute and late toxicities, and survival outcomes.

Main Results:

• HT-IMRT demonstrated significantly lower rates of erythema (34% vs. 61%) and moist desquamation (11% vs. 33%) compared to FiF-IMRT.
• Inverse IMRT provided more homogeneous dose coverage.
• Large breast volume, FiF-IMRT, and chemotherapy were independent predictors of acute toxicity. No significant differences in late toxicities or 5-year survival rates were observed.

Conclusions:

• HT-IMRT significantly reduces acute skin toxicity in whole-breast irradiation compared to FiF-IMRT.
• Inverse-planned IMRT, with careful optimization, can be integrated into routine practice for breast cancer treatment.
• No significant difference in late toxicities or oncologic outcomes between the evaluated IMRT techniques.