Skin Toxicity in Early Breast Cancer Patients Treated with Field-In-Field Breast Intensity-Modulated Radiotherapy versus Helical Inverse Breast Intensity-Modulated Radiotherapy: Results of a Phase III Randomised Controlled Trial

AimsSkin toxicity is a common adverse effect of breast radiotherapy. We investigated whether inverse-planned intensity-modulated radiotherapy (IMRT) would reduce the incidence skin compared with forward field-in-field IMRT (FiF-IMRT) in early stage cancer.Materials and methodsThis phase III randomised controlled trial whole-breast irradiation either FiF-IMRT or helical tomotherapy (HT-IMRT), as primary end point. Patients received 50 Gy 25 fractions were assessed to compare between treatment arms.ResultsIn total, 177 patients available for assessment median follow-up was 73.1 months. Inverse achieved more homogeneous coverage than FiF-IMRT; erythema moist desquamation higher HT-IMRT (61% versus 34%; P < 0.001; 33% 11%; 0.001, respectively). Multivariate analysis showed large volume, chemotherapy independent factors associated worse acute toxicity. There no difference arms late toxicities. The 5-year recurrence-free survival 96.3% both overall 97.4% HT-IMRT.ConclusionsOur study significant reduction using FiF-IMRT, without On basis these findings, could be used routine practice careful plan optimisation achieve required dose constraints organs at risk.