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Published in: BMC Cancer 1/2011

Open Access 01-12-2011 | Study protocol

Simultaneous integrated boost for adjuvant treatment of breast cancer- intensity modulated vs. conventional radiotherapy: The IMRT-MC2 trial

Authors: Vasileios Askoxylakis, Alexandra D Jensen, Matthias F Häfner, Leonie Fetzner, Florian Sterzing, Joerg Heil, Christof Sohn, Johannes Hüsing, Uta Tiefenbacher, Frederik Wenz, Jürgen Debus, Holger Hof

Published in: BMC Cancer | Issue 1/2011

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Abstract

Background

Radiation therapy is an essential modality in the treatment of breast cancer. Addition of radiotherapy to surgery has significantly increased local control and survival rates of the disease. However, radiotherapy is also associated with side effects, such as tissue fibrosis or enhanced vascular morbidity. Modern radiotherapy strategies, such as intensity modulated radiotherapy (IMRT), can shorten the overall treatment time by integration of the additional tumor bed boost significantly. To what extent this might be possible without impairing treatment outcome and cosmetic results remains to be clarified.

Methods/Design

The IMRT-MC2 study is a prospective, two armed, multicenter, randomized phase-III-trial comparing intensity modulated radiotherapy with integrated boost to conventional radiotherapy with consecutive boost in patients with breast cancer after breast conserving surgery. 502 patients will be recruited and randomized into two arms: patients in arm A will receive IMRT in 28 fractions delivering 50.4 Gy to the breast and 64.4 Gy to the tumor bed by integrated boost, while patients in arm B will receive conventional radiotherapy of the breast in 28 fractions to a dose of 50.4 Gy and consecutive boost in 8 fractions to a total dose of 66.4 Gy.

Discussion

Primary objectives of the study are the evaluation of the cosmetic results 6 weeks and 2 years post treatment and the 2- and 5-year local recurrence rates for the two different radiotherapy strategies. Secondary objectives are long term overall survival, disease free survival and quality of life.

Trial Registration

ClinicalTrials.gov Protocol ID: NCT01322854.
Appendix
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Literature
1.
go back to reference Askoxylakis V, Thieke C, Pleger ST, Most P, Tanner J, Lindel K, Katus HA, Debus J, Bischof M: Long-term survival of cancer patients compared to heart failure and stroke: a systematic review. BMC Cancer. 2010, 10: 105-10.1186/1471-2407-10-105.CrossRefPubMedPubMedCentral Askoxylakis V, Thieke C, Pleger ST, Most P, Tanner J, Lindel K, Katus HA, Debus J, Bischof M: Long-term survival of cancer patients compared to heart failure and stroke: a systematic review. BMC Cancer. 2010, 10: 105-10.1186/1471-2407-10-105.CrossRefPubMedPubMedCentral
2.
go back to reference Veronesi U, Cascinelli N, Mariani L, Greco M, Saccozzi R, Luini A, Agiolar M, Marubini E: Twenty-year follow-up of a randomized study comparing breast-conserving surgery with radical mastectomy for early breast cancer. N Engl J Med. 2002, 347: 1227-1232. 10.1056/NEJMoa020989.CrossRefPubMed Veronesi U, Cascinelli N, Mariani L, Greco M, Saccozzi R, Luini A, Agiolar M, Marubini E: Twenty-year follow-up of a randomized study comparing breast-conserving surgery with radical mastectomy for early breast cancer. N Engl J Med. 2002, 347: 1227-1232. 10.1056/NEJMoa020989.CrossRefPubMed
3.
go back to reference Fisher B, Anderson S, Bryant J, Margolese RG, Deutsch M, Fisher ER, Jeong JH, Wolmark N: Twenty-year follow-up of a randomized trial comparing total mastectomy, lumpectomy, and lumpectomy plus irradiation for the treatment of invasive breast cancer. N Engl J Med. 2002, 347: 1233-1241. 10.1056/NEJMoa022152.CrossRefPubMed Fisher B, Anderson S, Bryant J, Margolese RG, Deutsch M, Fisher ER, Jeong JH, Wolmark N: Twenty-year follow-up of a randomized trial comparing total mastectomy, lumpectomy, and lumpectomy plus irradiation for the treatment of invasive breast cancer. N Engl J Med. 2002, 347: 1233-1241. 10.1056/NEJMoa022152.CrossRefPubMed
4.
go back to reference Bartelink H, Horiot JC, Poortmans PM, Struikmans H, Van den Bogaert W, Fouquet A, Jager JJ, Hoogenraad WJ, Oei SB, Wárlám-Rodenhuis CC, Pierart M, Collette L: Impact of a higher radiation dose on local control and survival in breast-conserving therapy of early breast cancer: 10-year results of the randomized boost versus no boost EORTC 22881-10882 trial. J Clin Oncol. 2007, 25: 3259-3265. 10.1200/JCO.2007.11.4991.CrossRefPubMed Bartelink H, Horiot JC, Poortmans PM, Struikmans H, Van den Bogaert W, Fouquet A, Jager JJ, Hoogenraad WJ, Oei SB, Wárlám-Rodenhuis CC, Pierart M, Collette L: Impact of a higher radiation dose on local control and survival in breast-conserving therapy of early breast cancer: 10-year results of the randomized boost versus no boost EORTC 22881-10882 trial. J Clin Oncol. 2007, 25: 3259-3265. 10.1200/JCO.2007.11.4991.CrossRefPubMed
5.
go back to reference Jones HA, Antonini N, Hart AA, Peterse JL, Horiot JC, Collin F, Poortmans PM, Oei SB, Collette L, Struikmans H, Van den Bogaert WF, Fourquet A, Jager JJ, Schinagl DA, Wárlám-Rodenhuis CC, Bartelink H: Impact of pathological characteristics on local relapse after breast-conserving therapy: a subgroup analysis of the EORTC boost versus no boost trial. J Clin Oncol. 2009, 27: 4939-4947. 10.1200/JCO.2008.21.5764.CrossRefPubMedPubMedCentral Jones HA, Antonini N, Hart AA, Peterse JL, Horiot JC, Collin F, Poortmans PM, Oei SB, Collette L, Struikmans H, Van den Bogaert WF, Fourquet A, Jager JJ, Schinagl DA, Wárlám-Rodenhuis CC, Bartelink H: Impact of pathological characteristics on local relapse after breast-conserving therapy: a subgroup analysis of the EORTC boost versus no boost trial. J Clin Oncol. 2009, 27: 4939-4947. 10.1200/JCO.2008.21.5764.CrossRefPubMedPubMedCentral
6.
go back to reference Collette S, Collette L, Budiharto T, Horiot JC, Poortmans PM, Struikmans H, Van den Bogaert W, Fourquet A, Jager JJ, Hoogenraad W, Mueller RP, Kurtz J, Morgan DA, Dubois JB, Salamon E, Mirimanoff R, Bolla M, Van der Hulst M, Wárlám-Rodenhuis CC, Bartelink H, EORTC Radiation Oncology Group: Predictors of the risk of fibrosis at 10 years after breast conserving therapy for early breast cancer: a study based on the EORTC Trial 22881-10882 'boost versus no boost'. Eur J Cancer. 2008, 44: 2587-2599. 10.1016/j.ejca.2008.07.032.CrossRefPubMed Collette S, Collette L, Budiharto T, Horiot JC, Poortmans PM, Struikmans H, Van den Bogaert W, Fourquet A, Jager JJ, Hoogenraad W, Mueller RP, Kurtz J, Morgan DA, Dubois JB, Salamon E, Mirimanoff R, Bolla M, Van der Hulst M, Wárlám-Rodenhuis CC, Bartelink H, EORTC Radiation Oncology Group: Predictors of the risk of fibrosis at 10 years after breast conserving therapy for early breast cancer: a study based on the EORTC Trial 22881-10882 'boost versus no boost'. Eur J Cancer. 2008, 44: 2587-2599. 10.1016/j.ejca.2008.07.032.CrossRefPubMed
7.
go back to reference Early Breast Cancer Trialists' Collaborative Group: Favourable and unfavourable effects on long-term survival of radiotherapy for early breast cancer: an overview of the randomised trials. Lancet. 2000, 355: 1757-1770.CrossRef Early Breast Cancer Trialists' Collaborative Group: Favourable and unfavourable effects on long-term survival of radiotherapy for early breast cancer: an overview of the randomised trials. Lancet. 2000, 355: 1757-1770.CrossRef
8.
go back to reference Gagliardi G, Constine LS, Moiseenko V, Correa C, Pierce LJ, Allen AM, Marks LB: Radiation dose-volume effects in the heart. Int J Radiat Oncol Biol Phys. 2010, 76: 77-85. 10.1016/j.ijrobp.2009.04.093.CrossRef Gagliardi G, Constine LS, Moiseenko V, Correa C, Pierce LJ, Allen AM, Marks LB: Radiation dose-volume effects in the heart. Int J Radiat Oncol Biol Phys. 2010, 76: 77-85. 10.1016/j.ijrobp.2009.04.093.CrossRef
9.
go back to reference Marks LB, Yu X, Prosnitz RG, Zhou SM, Hardenbergh PH, Blazing M, Hollis D, Lind P, Tisch A, Wong TZ, Borges-Neto S: The incidence and functional consequences of RT-associated cardiac perfusion defects. Int J Radiat Oncol Biol Phys. 2005, 63: 214-223. 10.1016/j.ijrobp.2005.01.029.CrossRefPubMed Marks LB, Yu X, Prosnitz RG, Zhou SM, Hardenbergh PH, Blazing M, Hollis D, Lind P, Tisch A, Wong TZ, Borges-Neto S: The incidence and functional consequences of RT-associated cardiac perfusion defects. Int J Radiat Oncol Biol Phys. 2005, 63: 214-223. 10.1016/j.ijrobp.2005.01.029.CrossRefPubMed
10.
go back to reference Darby SC, Cutter DJ, Boerma M, Constine LS, Fajardo LF, Kodama K, Mabuchi K, Marks LB, Mettler FA, Pierce LJ, Trott KR, Yeh ET, Shore RE: Radiation-related heart disease: current knowledge and future prospects. Int J Radiat Oncol Biol Phys. 2010, 76: 656-665. 10.1016/j.ijrobp.2009.09.064.CrossRefPubMedPubMedCentral Darby SC, Cutter DJ, Boerma M, Constine LS, Fajardo LF, Kodama K, Mabuchi K, Marks LB, Mettler FA, Pierce LJ, Trott KR, Yeh ET, Shore RE: Radiation-related heart disease: current knowledge and future prospects. Int J Radiat Oncol Biol Phys. 2010, 76: 656-665. 10.1016/j.ijrobp.2009.09.064.CrossRefPubMedPubMedCentral
11.
go back to reference Kestin LL, Sharpe MB, Frazier RC, Vicini FA, Yan D, Matter RC, Martinez AA, Wong JW: Intensity modulation to improve dose uniformity with tangential breast radiotherapy: initial clinical experience. Int J Radiat Oncol Biol Phys. 2000, 48: 1559-1568. 10.1016/S0360-3016(00)01396-1.CrossRefPubMed Kestin LL, Sharpe MB, Frazier RC, Vicini FA, Yan D, Matter RC, Martinez AA, Wong JW: Intensity modulation to improve dose uniformity with tangential breast radiotherapy: initial clinical experience. Int J Radiat Oncol Biol Phys. 2000, 48: 1559-1568. 10.1016/S0360-3016(00)01396-1.CrossRefPubMed
12.
go back to reference Tomé WA, Jaradat HA, Nelson IA, Ritter MA, Mehta MP: Helical tomotherapy: image guidance and adaptive dose guidance. Front Radiat Ther Oncol. 2007, 40: 162-178.CrossRefPubMed Tomé WA, Jaradat HA, Nelson IA, Ritter MA, Mehta MP: Helical tomotherapy: image guidance and adaptive dose guidance. Front Radiat Ther Oncol. 2007, 40: 162-178.CrossRefPubMed
13.
go back to reference Goddu SM, Chaudhari S, Mamalui-Hunter M, Pechenaya OL, Pratt D, Mutic S, Zoberi I, Jeswani S, Powell SN, Low DA: Helical tomotherapy planning for left-sided breast cancer patients with positive lymph nodes: comparison to conventional multiport breast technique. Int J Radiat Oncol Biol Phys. 2009, 73: 1243-1251. 10.1016/j.ijrobp.2008.11.004.CrossRefPubMed Goddu SM, Chaudhari S, Mamalui-Hunter M, Pechenaya OL, Pratt D, Mutic S, Zoberi I, Jeswani S, Powell SN, Low DA: Helical tomotherapy planning for left-sided breast cancer patients with positive lymph nodes: comparison to conventional multiport breast technique. Int J Radiat Oncol Biol Phys. 2009, 73: 1243-1251. 10.1016/j.ijrobp.2008.11.004.CrossRefPubMed
14.
go back to reference Thilmann C, Zabel A, Grosser KH, Hoess A, Wannenmacher M, Debus J: Intensity-modulated radiotherapy with an integrated boost to the macroscopic tumor volume in the treatment of high-grade gliomas. Int J Cancer. 2001, 96: 341-349. 10.1002/ijc.1042.CrossRefPubMed Thilmann C, Zabel A, Grosser KH, Hoess A, Wannenmacher M, Debus J: Intensity-modulated radiotherapy with an integrated boost to the macroscopic tumor volume in the treatment of high-grade gliomas. Int J Cancer. 2001, 96: 341-349. 10.1002/ijc.1042.CrossRefPubMed
15.
go back to reference Sautter-Bihl ML, Budach W, Dunst J, Feyer P, Haase W, Harms W, Sedlmayer F, Souchon R, Wenz F, Sauer R, German Society of Radiation Oncology; German Cancer Society: DEGRO practical guidelines for radiotherapy of breast cancer I: breast-conserving therapy. Strahlenther Onkol. 2007, 183: 661-666. 10.1007/s00066-007-1811-1.CrossRefPubMed Sautter-Bihl ML, Budach W, Dunst J, Feyer P, Haase W, Harms W, Sedlmayer F, Souchon R, Wenz F, Sauer R, German Society of Radiation Oncology; German Cancer Society: DEGRO practical guidelines for radiotherapy of breast cancer I: breast-conserving therapy. Strahlenther Onkol. 2007, 183: 661-666. 10.1007/s00066-007-1811-1.CrossRefPubMed
16.
go back to reference Sautter-Bihl ML, Souchon R, Budach W, Sedlmayer F, Feyer P, Harms W, Haase W, Dunst J, Wenz F, Sauer R: DEGRO practical guidelines for radiotherapy of breast cancer II. Postmastectomy radiotherapy, irradiation of regional lymphatics, and treatment of locally advanced disease. Strahlenther Onkol. 2008, 184: 347-353. 10.1007/s00066-008-1901-8.CrossRefPubMed Sautter-Bihl ML, Souchon R, Budach W, Sedlmayer F, Feyer P, Harms W, Haase W, Dunst J, Wenz F, Sauer R: DEGRO practical guidelines for radiotherapy of breast cancer II. Postmastectomy radiotherapy, irradiation of regional lymphatics, and treatment of locally advanced disease. Strahlenther Onkol. 2008, 184: 347-353. 10.1007/s00066-008-1901-8.CrossRefPubMed
17.
go back to reference Vrieling C, Collette L, Bartelink E, Borger JH, Brenninkmeyer SJ, Horiot JC, Pierart M, Poortmans PM, Struikmans H, Van der Schueren E, Van Dongen JA, Van Limbergen E, Bartelink H: Validation of the methods of cosmetic assessment after breast-conserving therapy in the EORTC "boost versus no boost" trial. EORTC Radiotherapy and Breast Cancer Cooperative Groups. European Organization for Research and Treatment of Cancer. Int J Radiat Oncol Biol Phys. 1999, 45: 667-676. 10.1016/S0360-3016(99)00215-1.CrossRefPubMed Vrieling C, Collette L, Bartelink E, Borger JH, Brenninkmeyer SJ, Horiot JC, Pierart M, Poortmans PM, Struikmans H, Van der Schueren E, Van Dongen JA, Van Limbergen E, Bartelink H: Validation of the methods of cosmetic assessment after breast-conserving therapy in the EORTC "boost versus no boost" trial. EORTC Radiotherapy and Breast Cancer Cooperative Groups. European Organization for Research and Treatment of Cancer. Int J Radiat Oncol Biol Phys. 1999, 45: 667-676. 10.1016/S0360-3016(99)00215-1.CrossRefPubMed
18.
go back to reference Rose MA, Olivotto I, Cady B, Koufman C, Osteen R, Silver B, Recht A, Harris JR: Conservative surgery and radiation therapy for early breast cancer. Long-term cosmetic result. Arch Surg. 1989, 124: 153-157.CrossRefPubMed Rose MA, Olivotto I, Cady B, Koufman C, Osteen R, Silver B, Recht A, Harris JR: Conservative surgery and radiation therapy for early breast cancer. Long-term cosmetic result. Arch Surg. 1989, 124: 153-157.CrossRefPubMed
19.
go back to reference Montazeri A, Vahdaninia M, Harirchi I, Ebrahimi M, Khaleghi F, Jarvandi S: Quality of life in patients with breast cancer before and after diagnosis: an eighteen months follow-up study. BMC Cancer. 2008, 8: 330-10.1186/1471-2407-8-330.CrossRefPubMedPubMedCentral Montazeri A, Vahdaninia M, Harirchi I, Ebrahimi M, Khaleghi F, Jarvandi S: Quality of life in patients with breast cancer before and after diagnosis: an eighteen months follow-up study. BMC Cancer. 2008, 8: 330-10.1186/1471-2407-8-330.CrossRefPubMedPubMedCentral
20.
go back to reference Cho BC, Hurkmans CW, Damen EM, Zijp LJ, Mijnheer BJ: Intensity modulated versus non-intensity modulated radiotherapy in the treatment of the left breast and upper internal mammary lymph node chain: a comparative planning study. Radiother Oncol. 2002, 62: 127-136. 10.1016/S0167-8140(01)00472-8.CrossRefPubMed Cho BC, Hurkmans CW, Damen EM, Zijp LJ, Mijnheer BJ: Intensity modulated versus non-intensity modulated radiotherapy in the treatment of the left breast and upper internal mammary lymph node chain: a comparative planning study. Radiother Oncol. 2002, 62: 127-136. 10.1016/S0167-8140(01)00472-8.CrossRefPubMed
21.
go back to reference Hurkmans CW, Cho BC, Damen E, Zijp L, Mijnheer BJ: Reduction of cardiac and lung complication probabilities after breast irradiation using conformal radiotherapy with or without intensity modulation. Radiother Oncol. 2002, 62: 163-171. 10.1016/S0167-8140(01)00473-X.CrossRefPubMed Hurkmans CW, Cho BC, Damen E, Zijp L, Mijnheer BJ: Reduction of cardiac and lung complication probabilities after breast irradiation using conformal radiotherapy with or without intensity modulation. Radiother Oncol. 2002, 62: 163-171. 10.1016/S0167-8140(01)00473-X.CrossRefPubMed
22.
go back to reference Thilmann C, Sroka-Perez G, Krempien R, Hoess A, Wannenmacher M, Debus J: Inversely planned intensity modulated radiotherapy of the breast including the internal mammary chain: a plan comparison study. Technol Cancer Res Treat. 2004, 3: 69-75.CrossRefPubMed Thilmann C, Sroka-Perez G, Krempien R, Hoess A, Wannenmacher M, Debus J: Inversely planned intensity modulated radiotherapy of the breast including the internal mammary chain: a plan comparison study. Technol Cancer Res Treat. 2004, 3: 69-75.CrossRefPubMed
23.
go back to reference Bhatnagar AK, Brandner E, Sonnik D, Wu A, Kalnicki S, Deutsch M, Heron DE: Intensity modulated radiation therapy (IMRT) reduces the dose to the contralateral breast when compared to conventional tangential fields for primary breast irradiation. Breast Cancer Res Treat. 2006, 96: 41-46. 10.1007/s10549-005-9032-8.CrossRefPubMed Bhatnagar AK, Brandner E, Sonnik D, Wu A, Kalnicki S, Deutsch M, Heron DE: Intensity modulated radiation therapy (IMRT) reduces the dose to the contralateral breast when compared to conventional tangential fields for primary breast irradiation. Breast Cancer Res Treat. 2006, 96: 41-46. 10.1007/s10549-005-9032-8.CrossRefPubMed
24.
go back to reference Harsolia A, Kestin L, Grills I, Wallace M, Jolly S, Jones C, Lala M, Martinez A, Schell S, Vicini FA: Intensity-modulated radiotherapy results in significant decrease in clinical toxicities compared with conventional wedge-based breast radiotherapy. Int J Radiat Oncol Biol Phys. 2007, 68: 1375-1380. 10.1016/j.ijrobp.2007.02.044.CrossRefPubMed Harsolia A, Kestin L, Grills I, Wallace M, Jolly S, Jones C, Lala M, Martinez A, Schell S, Vicini FA: Intensity-modulated radiotherapy results in significant decrease in clinical toxicities compared with conventional wedge-based breast radiotherapy. Int J Radiat Oncol Biol Phys. 2007, 68: 1375-1380. 10.1016/j.ijrobp.2007.02.044.CrossRefPubMed
25.
go back to reference Pignol JP, Olivotto I, Rakovitch E, Gardner S, Sixel K, Beckham W, Vu TT, Trung P, Ackerman I, Paszat L: A multicenter randomized trial of breast intensity-modulated radiation therapy to reduce acute radiation dermatitis. J Clin Oncol. 2008, 26: 2085-2092. 10.1200/JCO.2007.15.2488.CrossRefPubMed Pignol JP, Olivotto I, Rakovitch E, Gardner S, Sixel K, Beckham W, Vu TT, Trung P, Ackerman I, Paszat L: A multicenter randomized trial of breast intensity-modulated radiation therapy to reduce acute radiation dermatitis. J Clin Oncol. 2008, 26: 2085-2092. 10.1200/JCO.2007.15.2488.CrossRefPubMed
26.
go back to reference Donovan E, Bleakley N, Denholm E, Evans P, Gothard L, Hanson J, Peckitt C, Reise S, Ross G, Sharp G, Symonds-Tayler R, Tait D, Yarnold J, Breast Technology Group: Randomised trial of standard 2D radiotherapy (RT) versus intensity modulated radiotherapy in patients prescribed breast radiotherapy. Radiother Oncol. 2007, 82: 254-264. 10.1016/j.radonc.2006.12.008.CrossRefPubMed Donovan E, Bleakley N, Denholm E, Evans P, Gothard L, Hanson J, Peckitt C, Reise S, Ross G, Sharp G, Symonds-Tayler R, Tait D, Yarnold J, Breast Technology Group: Randomised trial of standard 2D radiotherapy (RT) versus intensity modulated radiotherapy in patients prescribed breast radiotherapy. Radiother Oncol. 2007, 82: 254-264. 10.1016/j.radonc.2006.12.008.CrossRefPubMed
27.
go back to reference McDonald MW, Godette KD, Butker EK, Davis LW, Johnstone PA: Long-term outcomes of IMRT for breast cancer: a single-institution cohort analysis. Int J Radiat Oncol Biol Phys. 2008, 72: 1031-1040. 10.1016/j.ijrobp.2008.02.053.CrossRefPubMed McDonald MW, Godette KD, Butker EK, Davis LW, Johnstone PA: Long-term outcomes of IMRT for breast cancer: a single-institution cohort analysis. Int J Radiat Oncol Biol Phys. 2008, 72: 1031-1040. 10.1016/j.ijrobp.2008.02.053.CrossRefPubMed
Metadata
Title
Simultaneous integrated boost for adjuvant treatment of breast cancer- intensity modulated vs. conventional radiotherapy: The IMRT-MC2 trial
Authors
Vasileios Askoxylakis
Alexandra D Jensen
Matthias F Häfner
Leonie Fetzner
Florian Sterzing
Joerg Heil
Christof Sohn
Johannes Hüsing
Uta Tiefenbacher
Frederik Wenz
Jürgen Debus
Holger Hof
Publication date
01-12-2011
Publisher
BioMed Central
Published in
BMC Cancer / Issue 1/2011
Electronic ISSN: 1471-2407
DOI
https://doi.org/10.1186/1471-2407-11-249

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