Simultaneous Integrated Boost: Improving the Patient Journey During Breast Cancer Radiotherapy Safely

Abstract

Madam — We read with interest the UK IMPORT High trial abstract update demonstrating that simultaneous integrated boost (SIB) can be delivered safely in breast cancer without significantly increasing the risk of adverse events [ [1] Coles C.E. Griffin C.L. Kirby A.M. et al. Dose escalated simultaneous integrated boost radiotherapy for women treated by breast conservation surgery for early breast cancer: 3-year adverse effects in the IMPORT HIGH trial (CRUK/06/003). 2018 Google Scholar ]. A series of other prospective studies has reported similar outcomes, reinforcing the safety of using SIB post-conservation surgery [ 2 Franco P. Zeverino M. Migliaccio F. et al. Intensity-modulated and hypofractionated simultaneous integrated boost adjuvant breast radiation employing statics ports of tomotherapy (TomoDirect): a prospective phase II trial. J Cancer Res Clin Oncol. 2014; 140: 167-177 Crossref PubMed Scopus (44) Google Scholar , 3 Cooper B.T. Formenti-Ujlaki G.F. Li X. et al. Prospective randomized trial of prone accelerated intensity modulated breast radiation therapy with a daily versus weekly boost to the tumor bed. Int J Radiat Oncol Biol Phys. 2016; 95: 571-578 Abstract Full Text Full Text PDF PubMed Scopus (16) Google Scholar , 4 De Rose F. Fogliata A. Franceschini D. et al. Phase II trial of hypofractionated VMAT-based treatment for early stage breast cancer: 2-year toxicity and clinical results. Radiat Oncol. 2016; 11: 120 Crossref PubMed Scopus (36) Google Scholar , 5 Shin S.M. No H.S. Vega R.M. et al. Breast, chest wall, and nodal irradiation with prone set-up: results of a hypofractionated trial with a median follow-up of 35 months. Pract Radiat Oncol. 2016; 6: e81-e88 Abstract Full Text Full Text PDF PubMed Scopus (20) Google Scholar , 6 Mondal D. Julka P.K. Sharma D.N. et al. Accelerated hypofractionated adjuvant whole breast radiation with simultaneous integrated boost using volumetric modulated arc therapy for early breast cancer: a phase I/II dosimetric and clinical feasibility study from a tertiary cancer care centre of India. J Egypt Natl Canc Inst. 2017; 29: 39-45 Abstract Full Text Full Text PDF PubMed Scopus (9) Google Scholar , 7 Cante D. Petrucci E. Sciacero P. et al. Ten-year results of accelerated hypofractionated adjuvant whole-breast radiation with concomitant boost to the lumpectomy cavity after conserving surgery for early breast cancer. Med Oncol. 2017; 34: 152 Crossref PubMed Scopus (18) Google Scholar ]. SIB instead of sequential boost can complete the entire course of adjuvant radiation within 3 weeks while using a hypofractionated regimen, reducing indirect costs by at least 25%. Also, one extra patient can be treated for every three patients treated with SIB.