Originally published as JCO Early Release 10.1200/JCO.2008.19.0819 on October 14 2008

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Skin-Sparing Intensity-Modulated Radiotherapy of the Breast

Edwin Bölke, Christiane Matuschek, Stephan Gripp, Wilfried Budach

Department of Radiation Oncology, University Hospital Düsseldorf, Düsseldorf, Germany

Peter Arne Gerber

Department of Dermatology, University Hospital Düsseldorf, Düsseldorf, Germany

Matthias Peiper

Department of General, Visceral and Pediatric Surgery, University Hospital Düsseldorf, Düsseldorf, Germany

To the Editor:

We read with great interest the recent article by Jean-Philippe Pignol et al¹ and the comment by Vordermark² regarding a multicenter, double-blind, randomized clinical trial testing whether breast intensity-modulated radiation therapy (BIMRT) reduces the rate of acute skin reaction (notably moist desquamation), decreases pain, and finally improves the quality of life as compared with standard radiotherapy using wedges. We would like to note that with regard to recent studies from other institutes, observations of grade 3 and 4 skin toxicity rates of 36.7% (standard radiotherapy) and 27.1% (BIMRT) are a poor result. Notably, Osako et al³ showed that in 377 patients treated with conventional radiotherapy, only 77 (20%) and six (2%) had grade 2 or grade 3 radiation dermatitis, respectively. Even better results were achieved with hypofractionated radiotherapy. This is in accordance with observations in our institution. Furthermore, in our opinion, a long-term follow-up of 10 years would be necessary to support a general recommendation of BIMRT for breast cancer. Only with long-term follow-up can local control, overall survival, and cosmetic results be reliably evaluated. Taken together, at this stage we do not recommend the use of BIMRT as a standard procedure for breast cancer therapy.

AUTHORS’ DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST

The author(s) indicated no potential conflicts of interest.

NOTES

published online ahead of print atwww.jco.org on October 13, 2008

REFERENCES

1. Pignol JP, Olivotto I, Rakovitch E, et al: A multicenter randomized trial of breast intensity-modulated radiation therapy to reduce acute radiation dermatitis. J Clin Oncol 26:2085-2092, 2008[Abstract/Free Full Text]

2. Vordermark D: Skin-sparing intensity-modulated radiotherapy of the breast. J Clin Oncol 26:3292, 2008[Free Full Text]

3. Osako T, Oguschi M, Kumada M, et al: Acute radiation dermatitis and pneumonitis in Japanese cancer patients with whole breast hypofractionated radiotherapy compared to conventional radiotherapy. Jpn Clin Oncol 38:334-338, 2008[CrossRef]

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