On June 8, 2023, The Lancet published the IMPORT HIGH research report from University of Cambridge, Institute of Cancer Research of University of London, Royal Marsden NHS Foundation Trust and other hospitals and institutions. IMPORT HIGH is a multi-center, phase 3, non-inferiority, open-label, randomized controlled trial. It compares simultaneous tumor-bed boost radiotherapy (simultaneous whole breast and tumor-bed boost radiotherapy) and sequential boost radiotherapy (whole breast radiotherapy followed by tumor-bed boost radiotherapy). The results confirmed that the 5-year ipsilateral breast tumor relapse (IBTR) rate in all treatment groups was lower than the 5% originally expected in the population with high recurrence risk regardless of boost sequencing. Dose-escalation was not advantageous. The 5-year moderate or marked adverse event rates were low using small boost volumes. IMPORT HIGH revealed that simultaneous integrated boost (whole breast radiotherapy and tumor-bed boost) was safe and reduced patient visits.

Professor Zhao Dongli’s team from Department of Radiation Oncology of the First Affiliated Hospital (FAH) of Xi'an Jiaotong University (XJTU) conducted in-depth analysis and comments regarding this study. They evaluated the effect of breathing techniques used in the experiment on the treatment results. According to the Correspondence, most patients were initially scanned while free breathing, whereas deep-inspiratory breath-hold technique (DIBH) was implemented only at the end of the trial. This may have biased experimental results. In the previous study of the team, DIBH techniques significantly reduced the mean cardiac dose and the mean ipsilateral lung dose in patients with left-sided breast cancer compared with free breathing (SMD -1.86, 95% CI: 2.26-1.46, P<0.01). In addition, the team also proposed that such dose reduction achieved by DIBH techniques is expected to reduce late cardiopulmonary toxicities, thereby improving the overall safety and efficacy. These findings prompted Professor Zhao Dongli's team to further explore data processing and result interpretation of this study to ensure the accuracy and reliability of clinical application. On May 4, 2024, this article was published in The Lancet (IF=168.9) as a Correspondence entitled "Challenges for breast radiotherapy with SIB: the IMPORT HIGH trial". Professor Zhao Dongli is the first author. Physicist Lu Yongkai is the corresponding author. In the past five years, this column has published more than 12 articles contributed by scholars (teams) from Chinese mainland. This is the first time that XJTU Health Science Center publishes an article in the Correspondence column of The Lancet, with the first and corresponding authors from FAH.

Article Link:https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(24)00354-4/fulltext