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Breast Intensity-Modulated Radiation Therapy to Reduce Radiation Dermatitis

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Author(s): Jean-Philippe Pignol | Ivo Olivotto

Journal: European Journal of Clinical & Medical Oncology
ISSN 1759-8958

Volume: 2;
Issue: 2;
Start page: 97;
Date: 2010;
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Keywords: breast cancer | adjuvant radiotherapy | intensity-modulated radiation therapy (IMRT) | radiation dermatitis | randomized clinical trials

ABSTRACT
The majority of early-stage breast cancers are treated with breast-conserving surgery followed by adjuvant radiation treatment on the whole breast. Acute dermatitis is a frequent side-effect of adjuvant breast radiotherapy, and this treatment can also impair the long-term cosmetic result. Breast intensity-modulated radiation therapy (IMRT) is a technique that improves the radiation dose distribution in the breast, allowing the avoidance of “hotspots”. To review current evidence that breast IMRT provides a patient benefit, a MedLine search was done to identify articles reporting on this technique. A total of 63 manuscripts reporting on breast IMRT were identified. Fifty-six articles present original research data; the majority (80%) reported on physics or dosimetry, a smaller number on clinical outcomes (15%), and on health sciences or radiobiology (5%). Eight articles reported clinical outcomes, with six being single-institution retrospective or prospective cohort from three centers in the USA, and two reporting prospective randomized controlled trials were from the UK and Canada. Combining all these data, the clinical outcomes of nearly 780 patients receiving breast IMRT have been reported and compared with 767 patients receiving standard wedged radiotherapy. There is level 1 evidence that breast IMRT reduces acute dermatitis from a Canadian, multicenter, randomized, double-blinded, clinical trial, and there is level 1 evidence that breast IMRT improves the long-term cosmetic results from a UK randomized clinical trial.
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