Formenti Silvia C, Gidea-Addeo Daniela, Goldberg Judith D, Roses Daniel F, Guth Amber, Rosenstein Barry S, DeWyngaert Keith J
Department of Radiation Oncology, Division of Biostatistics, New York University Cancer Institute and New York University School of Medicine, New York, NY 10016, USA.
J Clin Oncol. 2007 Jun 1;25(16):2236-42. doi: 10.1200/JCO.2006.09.1041. Epub 2007 Apr 30.
To report the clinical feasibility of a trial of accelerated whole-breast intensity modulated radiotherapy, with the patient in prone position, optimally to spare the heart and lung.
Patients with stages I or II breast cancer, excised by breast conserving surgery with negative margins, were eligible for this institutional review board-approved prospective trial. Computed tomography simulation was performed with the patient prone on a dedicated breast board, in the exact position used for treatment. A dose of 40.5 Gy, delivered at 2.7 Gy in 15 fractions, was prescribed to the index breast with an additional concomitant boost of 0.5 Gy delivered to the tumor bed, for a total dose of 48 Gy to the lumpectomy site. Physics constraints consisted of limiting 5% of the heart volume to receive > or = 18 Gy and < or = 10% of the ipsilateral lung volume to receive > or = 20 Gy.
Between September 2003 and August 2005, 91 patients were enrolled on the study. Median length of follow-up was 12 months (range, 1 to 28 months). In all patients the technique was feasible and heart and lung sparing was achieved as prescribed by the protocol. Acute toxicities consisting mostly of reversible grades 1-2 skin dermatitis (67%) and fatigue (18%) occurred in 75 patients. One patient sustained a regional recurrence rapidly followed by distant metastases.
Accelerated whole breast intensity modulated radiotherapy in the prone position is feasible and it permits a drastic reduction in the volume of lung and heart tissue exposed to significant radiation.
报告一项加速全乳调强放疗试验的临床可行性，患者采用俯卧位，以最佳方式保护心脏和肺部。
I期或II期乳腺癌患者，经保乳手术切除且切缘阴性，符合本机构审查委员会批准的前瞻性试验标准。在患者俯卧于专用乳腺板上时进行计算机断层扫描模拟，采用与治疗时完全相同的体位。对靶乳给予40.5 Gy的剂量，分15次给予，每次2.7 Gy，同时对瘤床额外给予0.5 Gy的同步推量，使保乳部位的总剂量达到48 Gy。物理限制条件包括将心脏体积的5%限制在接受≥18 Gy且将同侧肺体积的≤10%限制在接受≥20 Gy。
2003年9月至2005年8月期间，91例患者纳入本研究。中位随访时间为12个月（范围1至28个月）。在所有患者中，该技术可行，并且按照方案规定实现了心脏和肺部的保护。75例患者出现急性毒性反应，主要为可逆的1 - 2级皮肤皮炎（67%）和疲劳（18%）。1例患者出现局部复发，随后迅速发生远处转移。
俯卧位加速全乳调强放疗是可行的，并且可以大幅减少接受显著辐射的肺和心脏组织的体积。
