Adding a tumor bed boost may increase the incidence of which of the fibrosis?

• The European Organisation for Research and Treatment of Cancer (EORTC) boost trial:
  • Enrolled patients with:
    • Stage I and II breast cancer
    • Treated with lumpectomy and axillary dissection
• Patients with surgical margins free from invasive disease were randomized to receive:
  • Whole-breast irradiation:
    • With or without a subsequent boost targeting the tumor bed
• The 20-year overall survival and breast cancer specific mortality:
  • Were similar between the two groups
• The overall rate of ipsilateral breast tumor recurrence (IBTR) was lower in the boost group:
  • 12% vs 16.4% at 20 years
  • The absolute risk reduction was greatest in younger patients:
    • Nearly a 12% difference for patients younger than age 40 years compared to a 3% difference in patients older than age 60 years
• The local control conferred by a boost:
  • Translated into fewer salvage surgeries
• Adding a boost:
  • Did not increase cardiac mortality, contralateral breast tumors, or second primary tumors
  • But did increase fibrosis and impacted cosmetic results
• Similar results were noted:
  • In the randomized Lyon boost trial
• REFERENCES
  • Bartelink H, Maingon P, Poortmans P, et al; European Organisation for Research and Treatment of Cancer Radiation Oncology and Breast Cancer Groups. Whole-breast irradiation with or without a boost for patients treated with breast-conserving surgery for early breast cancer: 20-year follow-up of a randomised phase 3 trial. Lancet Oncol. 2015;16:47-56.
  • Romestaing P, Lehingue Y, Carrie C, et al. Role of a 10-Gy boost in the conservative treatment of early breast cancer: results of a randomized clinical trial in Lyon, France. J Clin Oncol. 1997;15:963-968.

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