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  • [Radiother Oncol.] Postoperative radiotherapy with intensity-modulated radiation therapy versus 3-dimensional conformal radiotherapy in early breast cancer: A randomized clinical trial of KROG 15-03

    [Radiother Oncol.] Postoperative radiotherapy with intensity-modulated radiation therapy versus 3-dimensional conformal radiotherapy in early breast cancer: A randomized clinical trial of KROG 15-03 유방암 수술후 방사선치료 IMRT와 3D-CRT 무작위대조군연구 (KROG 15-03)

    가톨릭의대 / 최규혜, 안성자, 이종훈*

  • 출처
    Radiother Oncol.
  • 등재일
    2021 Jan
  • 저널이슈번호
    154:179-186.
  • 내용

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    Abstract
    Purpose: To investigate the safety and efficacy of intensity-modulated radiation therapy (IMRT) for early breast cancer compared with 3-dimensional conformal radiotherapy (3D-CRT) in a prospective and randomized trial.

    Methods and materials: From March 2015 to February 2018, 693 patients with pT1-2N0M0 early breast cancer who underwent breast-conserving surgery were enrolled and randomly assigned into IMRT and 3D-CRT. The primary endpoint was 3-year locoregional recurrence-free survival (LRRFS). The secondary endpoints were recurrence-free survival, overall survival, acute toxicity, target coverage index, irradiation dose to organs at risk, and fatigue inventory. The radiation dose for the 3D-CRT arm was 59.4 Gy in 33 fractions for 6.5 weeks. It was 57.4 Gy in 28 fractions with simultaneous integrated boost for 5.5 weeks for the IMRT arm.

    Results: Of 693 patients, 349 and 344 patients received 3D-CRT and IMRT, respectively. There was no significant difference in LRRFS between the two arms. Conformity index of planning target volume was significantly superior in the IMRT arm than the 3D-CRT arm (p < 0.001). The mean lung dose and V5-V50 for the ipsilateral lung were significantly lower in the IMRT arm than the 3D-CRT arm (all p < 0.05). The incidence of grade 2 or higher dermatitis was significantly lower in the IMRT arm (p = 0.009).

    Conclusion: Compared to 3D-CRT, IMRT showed similar results in locoregional tumor control but superior results in planning target volume coverage. When IMRT is used in breast cancer, the irradiation dose to an ipsilateral lung and skin toxicity can be reduced.

     

    Figure 1. CONSORT diagram

     

    (A)

    (B)

    Figure 2. 전체생존율 (A)과 국소영역 무재발 생존율 (B)의 생존곡선

     

     

    Affiliations

    Kyu Hye Choi  1 , Sung Ja Ahn  2 , Jae Uk Jeong  2 , Mina Yu  3 , Jin Hee Kim  4 , Bae Kwon Jeong  5 , Joo Hwan Lee  6 , Sung Hwan Kim  6 , Jong Hoon Lee  7
    1 Department of Radiation Oncology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
    2 Department of Radiation Oncology, Chonnam National University Hospital, Chonnam National University School of Medicine, Gwangju, Republic of Korea.
    3 Department of Radiation Oncology, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
    4 Department of Radiation Oncology, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Republic of Korea.
    5 Department of Radiation Oncology, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Republic of Korea.
    6 Department of Radiation Oncology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
    7 Department of Radiation Oncology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea. Electronic address: koppul@catholic.ac.kr.

  • 키워드
    Breast cancer; IMRT; Recurrence; Toxicity.
  • 연구소개
    이 연구는 대한방사선종양학회 그룹 (Korean Radiotherapy Oncology Group, KROG) 에서 다기관연구로 설계된 전향적 무작위 연구로, 조기 유방암에서 기존의 3차원적 방사선치료 계획 (three dimensional conformal radiotherapy, 3D-CRT)과 비교하여 세기조절 방사선치료 (intensity modulated radiotherapy, IMRT)의 질병의 조절 및 생존과 치료의 안전성을 평가하고자 하였습니다. 693명의 환자 중 349명과 344명의 환자가 각각 3D-CRT와 IMRT 계획으로 무작위 배정을 받아 치료를 받았고, 결과상 3D-CRT와 비교하여 IMRT는 국소 종양 제어에서 유사한 결과를 보이며, target coverage 면에서 우수한 결과를 나타냈습니다. 또한 IMRT 계획 시 동측 폐에 대한 방사선 조사량과 피부 독성이 감소하였습니다.
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