This Article Full Text (PDF) Purchase Article View Shopping Cart Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Save to my personal folders Download to citation manager Rights & Permissions Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Morgan, D. A.L. Articles by Robertson, J. F.R. Search for Related Content PubMed PubMed Citation Articles by Morgan, D. A.L. Articles by Robertson, J. F.R. Related Articles Related Reply Related Article Social Bookmarking                            What's this?

Boost or Not

Department of Clinical Oncology, Nottingham University Hospitals, Nottingham, United Kingdom

John F.R. Robertson

Division of Breast Surgery, University of Nottingham, Nottingham, United Kingdom

To the Editor:

We wish to comment on the paper by Bartelink et al¹ reporting a large series of patients treated with wide local excision and radiotherapy, and randomly assigned to receive either standard whole-breast irradiation (50 Gy in 25 fractions) or the same plus a boost of 16 Gy.

The boost may, statistically significantly, reduce the risk of local recurrence in patients older than 50 years, and the proportional reduction may be the same as for younger patients, but the absolute reduction in risk of recurrence in these patients is in fact only a few percent (the authors do not provide the exact figures, but this can be seen from the graphs in Fig 3 of the article).

Conversely, the use of a boost results in an increased incidence of moderate to severe fibrosis of approximately 20% (Fig 4 of the article). This obviously influences cosmesis, which is an important consideration for these women as they chose breast-conserving surgery rather than mastectomy.

In summary, only a small percentage of patients age older than 50 years receive any benefit from the boost, whereas a much larger percentage have worse results cosmetically from its use. What benefit there is—a small reduction in local recurrence—in this study has not been shown to translate into an improvement in overall survival.

Although we accept that there might be specific risk factors that could select an individual patient older than 50 years for boost due to an identifiable increased risk of local recurrence, our interpretation of these randomized data is that a boost in patients older than 50 years is certainly not warranted as the routine standard of care.

AUTHORS’ DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST

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

REFERENCE

1. Bartelink H, Horiot J-C, Poortmans PM, et al: Impact of 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 25:3259-3265, 2007[Abstract/Free Full Text]

CiteULike    Complore    Connotea    Del.icio.us    Digg    Facebook    Reddit    Technorati    Twitter    What's this?

Related Reply

• In Reply:
  Harry Bartelink, Jean-Claude Horiot, Philip Poortmans, and Laurence Collette
  JCO 2008 26: 1014 [Full Text]

Related Article

• 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
  Harry Bartelink, Jean-Claude Horiot, Philip M. Poortmans, Henk Struikmans, Walter Van den Bogaert, Alain Fourquet, Jos J. Jager, Willem J. Hoogenraad, S. Bing Oei, Carla C. Wárlám-Rodenhuis, Marianne Pierart, and Laurence Collette
  JCO 2007 25: 3259-3265 [Abstract] [Full Text]

This Article Full Text (PDF) Purchase Article View Shopping Cart Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Save to my personal folders Download to citation manager Rights & Permissions Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Morgan, D. A.L. Articles by Robertson, J. F.R. Search for Related Content PubMed PubMed Citation Articles by Morgan, D. A.L. Articles by Robertson, J. F.R. Related Articles Related Reply Related Article Social Bookmarking                            What's this?