Radiation therapy using a simultaneously integrated boost for early-stage breast cancer

Abstract

Evaluation of: van der Laan HP, Dolsma WV, Maduro JH et al.: Three-dimensional conformal simultaneously integrated boost technique for breast-conserving therapy. Int. J. Radiat. Oncol. Biol. Phys. 68(4), 1018–1023 (2007). Radiotherapy of 25 daily fractions of 2 Gy after breast-conserving surgery is effective in reducing the risk of a local recurrence. An extra boost dose of eight daily fractions of 2 Gy reduces this risk even further by a factor of 1.7. However, the extended treatment time is not patient friendly and is more labor intensive. With new, advanced equipment, it is now possible to use a so-called simultaneous integrated boost (SIB) technique to prevent these downsides. With this technique, the boost dose is integrated into the standard dose fractions, thus reducing the number of times a patient has to be irradiated. However, the initial implementation of this technique is very labor intensive and requires profound knowledge of the radiotherapy treatment planning system and treatment unit. In their article, van der Laan and colleagues present an SIB technique which is easier to implement than a sophisticated (inversely planned) SIB technique. Moreover, they are the first authors to present data on acute skin toxicity using this technique and fractionation schedule. Their work contributes significantly to the efforts of clinical physicists, radiation oncologists and radiation therapists worldwide to improve breast cancer patient care by the safe implementation of new, advanced radiotherapy technology. However, one has to realize that implementing such a technique still requires accurate knowledge of the target volume delineation and patient set-up accuracy in each institution. Also, boost volume changes may occur during treatment, which must be taken into account. Data are becoming available on this, and clinical trials investigating even higher boost doses or more conformal treatment techniques are being conducted.