Spare me.

There are at least a couple of scenarios where you might find yourself pulling the trigger for adjuvant intensity modulated radiation (IMRT) for breast cancer. Most commonly, IMRT is used when struggling to achieve heart constraints for a left-sided comprehensive nodal target. Nowadays, you may even get approval to use it for accelerated partial breast irradiation (APBI). Well, this prospective randomized trial was so bold as to assess its utility for conventionally-fractionated whole breast irradiation (WBI) with the even bolder primary endpoint of local control. To no one's surprise, among the 693 women with early-stage breast cancer assessed, survival free from local recurrence at 3 years was 99% rafter receiving WBI via either standard 3D techniques or IMRT—the latter with a simultaneous tumor bed boost). However, also without surprise, a number of dosimetric measures were improved with IMRT. Most interesting, grade 2+ dermatitis was significantly better with IMRT (28%) than with 3D (37%), presumably due to intentional 4mm skin spring target volumes. TBL: WBI via IMRT can reduce dermatitis, but the jury is out on whether that is worth the extra effort (ok, cost). | Choi, Radiother Oncol 2020

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