Table 1.
Characteristics and findings of analyzed studies
| Study, Year | Center | Number of patients | Inclusion criteria | Median follow-up (months) | Planning/treatment technique | Dose, Gy (dose/fraction, Gy) | Target definition | Outcome | Toxicity | Notes |
|---|---|---|---|---|---|---|---|---|---|---|
| Donovan et al,12 2007 | Royal Marsden Hospital | 306 | Breast size and shape with higher risk of normal tissue change | 60 | 2D versus IMRT | 50 (2.0)+11.1a (2.22) | NR | NR | 3D-IMRT technique reduces incidence of changes in breast appearance | No significant differences in terms of breast discomfort, breast hardness, or QoL |
| Mulliez et al,13 2013 | Ghent University | 100 | Large breast (European cup size C or more) | NR | Supine multibeam IMRT versus prone tangential IMRT | 40.05 (2.67)+10a (2.5) | Whole breast (PTV for optimization: PTV – 7 mm skin-zone) | NR | Prone IMRT reduces acute skin desquamation, dermatitis, edema, pruritus, pain | IMRT improves dose coverage and homogeneity and reduces overdosage and lung irradiation |
| Barnett et al,14 2011; Barnett et al,15 2012; Mukesh et al,16 2012; Mukesh et al,17 2014 |
Cambridge University | 815 | >2 cc receiving >107% of prescribed dose with standard tangential plans |
24 | Standard RT versus forward-planned IMRT | 40 (2.67)+ nodal/tumor bed (NR) | NR | NR | IMRT increases cosmesis, reduces skin telangiectasia by photographic, and clinical assessment However, PROMs: no differences | PROMs results were affected by large breast volume, younger age, baseline postsurgical cosmesis, postoperative infections |
| Livi et al,18 2015; Meattini et al,19 2015 |
Florence University | 520 | Age >40 years; tumor <2.5 cm | 60 | WB 3D-RT versus IMRT-APBI “step-and- shoot” technique | 50 (2)+10a versus 30 (6) | PTV: 4 mm inside the ipsilateral lung; 3 mm from skin | OS: WB: 96.6% versus IMRT-APBI: 99.4%; IBRT: 1.5% in both arms | APBI reduces acute and late toxicity; improves cosmetic outcome | Results confirmed in subanalysis on 117 patients older than 70 years |
| Pignol et al,20 2008; Pignol et al,21 2016 |
Multicentric (Canadian trial) | 331 241 | Early-stage BC with ≤3 nodes | 117.6 | IMRT versus standard wedge RT | 50 (2)+16a | No PTV and organs at risk definition; CTV: 95% of prescribed dose | NR | IMRT reduces moist desquamation; no differences in chronic breast pain, cosmesis, QoL | Younger age and pain during RT increase chronic pain; acute moist desquamation increases late subcutaneous effects |
Note:
a
Boost.
Abbreviations: APBI, accelerated partial breast irradiation; CTV, clinical target volume; IBRT, ipsilateral breast tumor recurrence; IMRT, intensity modulated radiation therapy; NR, not reported; OS, overall survival; PROMs, Patients Reported Outcome Measures; PTV, planning target volume; QoL, quality of life; RT, radiotherapy; WB, whole breast; 3D-RT, three-dimensional radiotherapy; 2D, two-dimensional.