Improving Radiotherapy for Breast Cancer
19 May 2007 – Radiotherapy for breast cancer has been shown to contribute to long-term survival. However this benefit is partly offset by side effects such as radiation induced heart disease, pneumonitis and cosmetic effects such as breast pain and distortion of breast appearance.
The Departments of Clinical Oncology and Physics have utilised their developments in electronic portal imaging and intensity modulated radiotherapy (IMRT) to devise a new treatment method designed to reduce these side effects.
The new treatment method was evaluated in a randomised clinical trial. 306 women were randomised between the IMRT treatment and the standard treatment as control arm. The primary endpoint was change in breast appearance scored from serial photographs taken before radiotherapy and at 1, 2 and 5 years post-treatment. Secondary endpoints included patient self assessment of quality of life. Results were also evaluated in terms of physical dose distributions.
The trial showed a significant benefit associated with the use of IMRT. The control arm patients were 1.7 times (95% confidence interval 1.2-2.5, p=0.008.) more likely to have a change in breast appearance than the IMRT arm patients. Also significantly fewer patients in the IMRT group developed palpable induration assessed clinically in the centre of the breast, pectoral fold, infra-mammary fold and at the boost site. To our knowledge this is the world’s first randomised trial of IMRT and the first study to show an outcome benefit from IMRT. Also the new treatment has not significantly added to the treatment costs.
This work demonstrates: the translation of our science from the laboratory all the way to routine clinical practice, i.e. "bench to bedside"; collaboration between our two organisations; and the synergistic combination of expertise of several professional groups, including clinical oncologists, physicists, statisticians, epidemiologists, radiographers and nurses.
