Current role of modern radiotherapy techniques in the management of breast cancer

Table 1 Randomized phase III trials of intensity modulated radiation therapy for breast cancer

Ref.	N		FU (mo)	End-points	IMRT	Non IMRT	P value	Outcomes reported
	IMRT	2D RT
Donovan et al[32], 2007	150	156	N/A	Distribution of any change in breast appearance between the presence or absence of doses > 105%	OR, 2.6; 95%CI: 1.1-6		0.03	DC, LAE, QOL
				Photographic assessment of any change in breast appearance at 1, 2 and 5 yr	OR, 1.7; 95%CI; 1.2-2.5		0.008
				Physician assessment of breast induration at 5-yr, %
				Centre of the breast	21	32	0.02
				Pectoral fold	22	29	0.006
				İnframammary fold	17	24	0.009
				Boost site	37	61	< 0.001
Pignol et al[30], 2008	170	161	N/A	Acute skin toxicity (Gr 3-4), %	27.1	36.7	0.06	DC, AAE, QOL
				Moist desquamation (all breast), %	31.2	47.8	0.002
				Moist desquamation (inframammary crease), %	26.5	43.5	0.001
				Pain (Gr 2-4), %
Barnett et al[31], 2012	411	404	241	Photographic assessment of breast shrinkage at 2 yr	OR, 1.51; 95%CI: 0.83-1.58		0.41	AAE, LAE, QOL
				Acute toxicity (Gr ≥ 2)	OR, 1.00; 95%CI: 0.76-1.34		0.97
				Telangiectasia	OR, 1.68; 95%CI: 1.13-2.50		0.009
				Moderate or poor overall cosmesis (good baseline surgical cosmesis)	OR, 0.63; 95%CI: 0.39-1.03		0.061
				Patient reported
				Breast pain, %	46.7	37.3	0.98
				Oversensitivity, %	47.1	35	0.43
Mukesh et al[33], 2013	228	237	601	Photographic assessment of breast shrinkage at 5 yr	OR, 0.79; 95%CI: 0.55-1.14		0.21	LAE, TRO
				Teleangiectasia	OR, 0.58; 95%CI: 0.36-0.92		0.021
				Overall cosmesis	OR, 0.68; 95%CI: 0.48-0.96		0.027
				Breast edema	OR, 0.74; 95%CI: 0.48-1.15		0.18
				Tumor bed induration	OR, 0.76; 95%CI: 0.54-1.06		0.11
				Pigmentation	OR, 0.80; 95%CI: 0.46-1.38		0.42
				5-yr overall survival, %	91.7	92.5	0.88
				5-yr locoregional recurrence, %	1.35	2.56	0.36

¹Minimum average follow-up. IMRT: Intensity modulated radiotherapy; 2D RT: Two dimensional radiotherapy; N: Number of patients; FU: Follow-up; DC: Dosimetry characteristics; AAE: Acute adverse effects; LAE: Late adverse effects; TRO: Treatment related outcomes; QOL: Quality of life; Gr: Grade; N/A: Not available; NS: Not significant.