A prospective study of intensity-modulated radiotherapy with integrated boost after breast conservative surgery in breast cancer patients

Abstract

Objective To prospectively evaluate the efficacy and toxicity of intensity modulated radiotherapy (IMRT) with integrated boost after conservative surgery in breast cancer patients. Methods From January 2006 to June 2010, 128 patients with stages I-Ⅲ breast cancer treated with breast conservative surgery were recruited. All patients received whole breast IMRT with integrated tumor bed boost. A total dose of 50 Gy in 25 fractions with 2 Gy per fraction was delivered to the whole breast, while 60 Gy with 2. 4 Gy per fraction was delivered to the tumor bed concomitantly. Supraclavicular fossa was irradiated to 50 Gy in 9 patients (7.1%) who more than 3 involved axillary lymph nodes. 104 patients (81. 3%) received chemotherapy. 93 (94.9%) of the 98 patients who positive hormone receptor received endocrine therapy. Cosmetic evaluation is based on the Harvard system. Acute and late toxicities were scored according to CTCAE version 3. Survival rates were calculated by Kaplan-Miere method. Results The following-up rate was 100%. The 5 -year locoregional recurrence-free survival, disease-free survival and overall survival was 98. 4%, 97.7%, and 95.3%, respectively. The acute skin toxicity was grade 1 in 65.6%, grade 2 in 15.6%, and grade 3 in 2. 3% of all patients. Grade 2 radiation pneumonitis (RP) developed in 4.7% of this cohort, grade 1 in 22.5%. Grade 1-2 arm edema developed in 28.9%. One patient (0.8%) developed whole breast depigmentation. Four patients (3. 1% ) developed chromatosis. 77. 3% of patients had excellent or cosmetic outcome at 5 years, compared to 85. 9% of patients before radiotherapy. However, 28 patients (21.9%) had fair cosmetic outcome and 1 patient had poor appearance at 5 years. Eighteen patients (14. 1%) experienced improved cosmetic outcome at 5 years compare to that before radiotherapy while 34 patients (26.6%) an inferior appearance. Conclusions IMRT with integrated boost after breast-conserving surgery for breast cancer patients is well tolerated, with relatively good cosmetic outcome and moderate toxicity. Meanwhile, 5-year local control and survival are excellent. Key words: Breast neoplasm/breast conservative therapy; Breast neoplasm/concomitant integrated boost radiotherapy; Prognosis; Untoward effect