Theodore Edward Yaeger MD, Presenter: Nothing to Disclose

Accelerated radiation is being studied as an alternative to conventional radiation for early stage breast cancers.This report is to finalize the results of a technique to accelerate the radiotherapy course consistent with the American Society Radiation Oncology (ASTRO) 'Choose Wisely' recommendations. Intensity modulated radiation therapy (IMRT) using concurrent seroma radiation with conventional whole breast prophylaxis is studied. 

Patients older than 50 years with stage 0,1, or early 2 breast cancers were planned for both conventional 3-D tangents versus accelerated IMRT. Plans that developed improved dose homogenity were treated with accalerated IMRT over 5 weeks. Patients without plan improvements were treated with conventional technique (half-beam blocked tangents to boost) over 6.5 weeks.  The populations are compared for demographics, treatment tolerance, cosmesis and local control. The originlal intent is to prove non-inferiority. 

During 6 years of accural for conservation radiation to early stage breast cancers 73 patients were treated with either conventional or IMRT techniques. The beam-modulation technique offered shorter course IMRT if improved dosing was assured. All 73 patients were evaluated with dosimetry planning and 38 were eligible for IMRT. 35 patients had no improvement in their plans (thus treated conventionally). All patients were judged for treatment tolerance and local control, prospectively. No patient in either group experienced a local or global failure with 3.5 years average follow-up. However nearly 50% of patients treated with tangent fields developed treatment required skin reactions.  Only one in the IMRT group required skin care. No patient in the IMRT group developed global breast edema or any cosmetic defect. Pain scores and cosmetic results consistently favored the IMRT group as juged by the patients. Both groups had similar demographics, stage distributions, and prescribed doses.  

Beam-modulated accelerated radiotherapy delivers tumor control probabuilities similar to conventional radiation for breast conservation.  For all, but especially larger volume women, IMRT significantly enhances treatment tolerances and yields improved cosmetic outcomes.  

Beam-modulated accelerated radiation therapy is a shortened-course, non-inferior alternative for larger volume, low nodal risk early stage breast cancer patients seeking a breast conservation choice.

Yaeger, T, Solid Modulated Accelerated Radiation Therapy (SMART) for Early Stage Breast Cancer Conservation: Final Results.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14006130.html