Recht Abram, Ancukiewicz Marek, Alm El-Din Mohamed A, Lu Xing-Qi, Martin Chrystalla, Berman Stuart M, Hirsch Ariel E, Kachnic Lisa A, Katz Angela, MacDonald Shannon, Nedea Elena A, Stevenson Mary Ann, Powell Simon N, Taghian Alphonse G
Beth Israel Deaconess Medical Center, Department of Radiation Oncology, Boston MA 02215, USA.
J Clin Oncol. 2009 Aug 20;27(24):3887-93. doi: 10.1200/JCO.2008.20.0121. Epub 2009 Jul 20.
There are no data on how complication rates after accelerated partial-breast irradiation delivered by three-dimensional conformal radiotherapy are affected by treatment technique. We therefore examined the risk of pneumonitis in relation to lung dose-volume parameters.
Our prospective dose-escalation trial enrolled 198 treated patients from 2003 to 2007. Patients received 32 or 36 Gy in 4-Gy fractions, given twice daily: 29 (14%) were treated with pure photons; 149 (77%) with mixed photons and electrons; and 20 (10%) with protons.
There were four cases of pneumonitis at 4, 4, 7, and 9 months after treatment. All were in the 36-Gy cohort and were treated with pure photons. The risk of pneumonitis for the two cohorts combined was: 17% (four of 24) for an ipsilateral lung volume (ILV) receiving 20 Gy or higher (ILV, 20 Gy) of 3% or higher (P = .0002 for comparison to ILV 20 Gy < 3%, Fisher's exact test); 20% (four of 20) for an ILV 10 Gy of 10% or higher (P = .0001); and 15% (four of 26) for an ILV 5 Gy of 20% or higher (P = .0002).
The risk of pneumonitis appeared related to the ILV treated. This volume can be reduced by using mixed photons and electron when possible. We recommend that the ILV 20 Gy should be lower than 3%, the ILV 10 Gy lower than 10%, and the ILV 5 Gy lower than 20% when purely coplanar techniques are used.
尚无关于三维适形放疗进行加速部分乳腺照射后的并发症发生率如何受治疗技术影响的数据。因此，我们研究了与肺剂量体积参数相关的肺炎风险。
我们的前瞻性剂量递增试验在2003年至2007年纳入了198例接受治疗的患者。患者接受32或36 Gy，分4 Gy分次给予，每天两次：29例（14%）接受纯光子治疗；149例（77%）接受光子和电子混合治疗；20例（10%）接受质子治疗。
治疗后4、4、7和9个月出现4例肺炎。所有病例均在36 Gy队列中，且接受纯光子治疗。两个队列合并后的肺炎风险为：同侧肺体积（ILV）接受20 Gy或更高剂量（ILV 20 Gy）且占3%或更高时为17%（24例中的4例）（与ILV 20 Gy < 3%相比，P = .0002，Fisher精确检验）；ILV 10 Gy占10%或更高时为20%（20例中的4例）（P = .0001）；ILV 5 Gy占20%或更高时为15%（26例中的4例）（P = .0002）。
肺炎风险似乎与接受治疗的ILV有关。尽可能使用光子和电子混合治疗可减少该体积。我们建议，当使用纯共面技术时，ILV 20 Gy应低于3%，ILV 10 Gy低于10%，ILV 5 Gy低于20%。
