Concurrent Versus Sequential Radiation Dose Escalation to the Surgical Cavity for Conservative Treatment of High-Risk Early Breast Cancer: NRG/RTOG 1005 Phase III Trial

PURPOSE: For patients with breast cancer undergoing breast conservation, escalating the dose (boost) of radiation to the lumpectomy cavity after whole-breast irradiation (WBI) reduces ipsilateral breast recurrence (IBR) but extends treatment duration. This phase III trial investigated whether boost delivery during WBI versus after WBI provides noninferior IBR and preserves cosmetic appearance. METHODS: NRG/RTOG 1005 randomly assigned patients at higher risk for IBR after lumpectomy and axillary surgery to either a sequential boost of 12 Gy in six fractions(F) or 14 Gy in 7F after WBI of 50 Gy in 25F or 42.7 Gy in 16F (sequential arm) or a concurrent boost of 8 Gy in 15F of 0.53 Gy per day with WBI of 40 Gy in 15F (concurrent arm) using 3-dimensional conformal radiation therapy (RT) or intensity-modulated RT. Based on 1.59% 5-year IBR for the sequential arm, defining the noninferiority margin as a hazard ratio upper limit on the 90% CI of 2.12, 2,312 patients provide 80% power for noninferiority of IBR as first recurrence for the concurrent arm. Secondary end points included disease-free survival and overall survival, adverse events (AEs), and cosmetic outcomes. RESULTS: = .037. No differences were observed in AEs, cosmetic outcomes, or survival between arms. CONCLUSION: Concurrent boost during WBI results in noninferior IBR compared with sequential boost without worsening toxicity or cosmetic outcomes and reduces overall treatment time.

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Publication Details

Journal
Journal of Clinical Oncology
Published
2026-05-11
DOI
https://doi.org/10.1200/jco-25-02465
Primary Topic
Breast Cancer Treatment Studies
Type
article
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article

Concurrent Versus Sequential Radiation Dose Escalation to the Surgical Cavity for Conservative Treatment of High-Risk Early Breast Cancer: NRG/RTOG 1005 Phase III Trial

Matthew M. Poppe, A. Hoover, Janice K. Tomberlin, Barry S. Rosenstein et al.
Journal of Clinical Oncology
Breast Cancer Treatment Studies
article

Concurrent Versus Sequential Radiation Dose Escalation to the Surgical Cavity for Conservative Treatment of High-Risk Early Breast Cancer: NRG/RTOG 1005 Phase III Trial

Matthew M. Poppe, A. Hoover, Janice K. Tomberlin, Barry S. Rosenstein, Jennifer Moughan, Douglas W. Arthur, Julia R. White, Richard J. Bleicher, Tarek Hijal, Bethany M. Anderson, Søren M. Bentzen, Sally B. Cheston, Michele Y. Halyard, JANICE LYONS, Kathryn Winter, Frank A. Vicini, B Movsas, Ivy A. Petersen, S. Jhawar, Francisco E. Perera, Gary M. Freedman, Alphonse Taghian, X. Allen Li, Wendy A. Woodward, Samantha A. Seaward
article en

Abstract

PURPOSE: For patients with breast cancer undergoing breast conservation, escalating the dose (boost) of radiation to the lumpectomy cavity after whole-breast irradiation (WBI) reduces ipsilateral breast recurrence (IBR) but extends treatment duration. This phase III trial investigated whether boost delivery during WBI versus after WBI provides noninferior IBR and preserves cosmetic appearance. METHODS: NRG/RTOG 1005 randomly assigned patients at higher risk for IBR after lumpectomy and axillary surgery to either a sequential boost of 12 Gy in six fractions(F) or 14 Gy in 7F after WBI of 50 Gy in 25F or 42.7 Gy in 16F (sequential arm) or a concurrent boost of 8 Gy in 15F of 0.53 Gy per day with WBI of 40 Gy in 15F (concurrent arm) using 3-dimensional conformal radiation therapy (RT) or intensity-modulated RT. Based on 1.59% 5-year IBR for the sequential arm, defining the noninferiority margin as a hazard ratio upper limit on the 90% CI of 2.12, 2,312 patients provide 80% power for noninferiority of IBR as first recurrence for the concurrent arm. Secondary end points included disease-free survival and overall survival, adverse events (AEs), and cosmetic outcomes. RESULTS: = .037. No differences were observed in AEs, cosmetic outcomes, or survival between arms. CONCLUSION: Concurrent boost during WBI results in noninferior IBR compared with sequential boost without worsening toxicity or cosmetic outcomes and reduces overall treatment time.

Journal of Clinical Oncology
University of Maryland, Baltimore (US), Fox Chase Cancer Center (US), The University of Texas MD Anderson Cancer Center (US), Virginia Commonwealth University (US), Medical College of Wisconsin (US), University of Utah (US), Texas Oncology (US), Howard County General Hospital (US), Huntsman Cancer Institute (US), McGill University Health Centre (CA), Kaiser Permanente Oakland Medical Center (US), Henry Ford Hospital (US), Massachusetts General Hospital (US), The University of Kansas Cancer Center (US), Mount Sinai Hospital (US), University of Wisconsin Carbone Cancer Center (US), Mount Vernon Cancer Centre (GB), Occupational Cancer Research Centre (CA), Mayo Clinic in Arizona (US), Mayo Clinic Hospital (US), Michigan Healthcare Professionals (US), NRG Oncology (US), U-M Rogel Cancer Center (US), The Ohio State University (US), Case Western Reserve University (US), University of Pennsylvania (US)
Openalex Percentile: Top 7%
Breast Cancer Treatment Studies
DOISourceOpenAlex
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