Nutritional Results After Target Volume Reduction Of Intensity-Modulated Radiotherapy Following Induction Chemotherapy In Locoregionally Advanced Nasopharyngeal Cancer: A Phase 3, Multicenter, Randomized Controlled Trial

Purpose There are few randomized controlled trial data to confirm that improved homogeneity with simple intensity-modulated radiotherapy (IMRT) decreases late breast tissue toxicity. The Cambridge Breast IMRT trial investigated this hypothesis, and the 5-year results are reported. Patients and Methods Standard tangential plans of 1,145 trial patients were analyzed; 815 patients had inhomogeneous plans (≥ 2 cm3 receiving 107% of prescribed dose: 40 Gy in 15 fractions over 3 weeks) and were randomly assigned to standard radiotherapy (RT) or replanned with simple IMRT; 330 patients with satisfactory dose homogeneity were treated with standard RT and underwent the same follow-up as the randomly assigned patients. Breast tissue toxicities were assessed at 5 years using validated methods: photographic assessment (overall cosmesis and breast shrinkage compared with baseline pre-RT photographs) and clinical assessment (telangiectasia, induration, edema, and pigmentation). Comparisons between different groups were analyzed using polychotomous logistic regression. Results On univariate analysis, compared with standard RT, fewer patients in the simple IMRT group developed suboptimal overall cosmesis (odds ratio [OR], 0.68; 95% CI, 0.48 to 0.96; P = .027) and skin telangiectasia (OR, 0.58; 95% CI, 0.36 to 0.92; P = .021). No evidence of difference was seen for breast shrinkage, breast edema, tumor bed induration, or pigmentation. The benefit of IMRT was maintained on multivariate analysis for both overall cosmesis (P = .038) and skin telangiectasia (P = .031). Conclusion Improved dose homogeneity with simple IMRT translates into superior overall cosmesis and reduces the risk of skin telangiectasia. These results are practice changing and should encourage centers still using two-dimensional RT to implement simple breast IMRT.

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First results of a phase III multicenter randomized controlled trial of intensity modulated (IMRT) versus conventional radiotherapy (RT) in head and neck cancer (PARSPORT: ISRCTN48243537)

Journal of Clinical Oncology ◽

10.1200/jco.2009.27.15_suppl.lba6006 ◽

2009 ◽

Vol 27 (15_suppl) ◽

pp. LBA6006-LBA6006

Author(s):

C. Nutting ◽

R. A'Hern ◽

M. S. Rogers ◽

M. A. Sydenham ◽

F. Adab ◽

...

Keyword(s):

Randomized Controlled Trial ◽

Head And Neck Cancer ◽

Controlled Trial ◽

Phase Iii ◽

Conventional Radiotherapy ◽

Intensity Modulated ◽

Randomized Controlled ◽

Multicenter Randomized Controlled Trial ◽

First Results ◽

Final Text

LBA6006 The full, final text of this abstract will be available in Part II of the 2009 ASCO Annual Meeting Proceedings, distributed onsite at the Meeting on May 30, 2009, and as a supplement to the June 20, 2009, issue of the Journal of Clinical Oncology. [Table: see text]

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