Radiotherapy Department, Regina Elena National Cancer Institute, Rome, Italy.
J Exp Clin Cancer Res. 2010 Jan 25;29(1):9. doi: 10.1186/1756-9966-29-9.
Accelerated hypofractionation is an attractive approach for adjuvant whole breast radiotherapy. In this study we evaluated the adverse effects at least 3 years post an accelerated hypofractionated whole breast radiotherapy schedule.
From October 2004 to March 2006, 39 consecutive patients aged over 18 years with pTis, pT1-2, pN0-1 breast adenocarcinoma who underwent conservative surgery were treated with an adjuvant accelerated hypofractionated radiotherapy schedule consisting of 34 Gy in 10 daily fractions over 2 weeks to the whole breast, followed after 1 week by an electron boost dose of 8 Gy in a single fraction to the tumour bed. Skin and lung radiation toxicity was evaluated daily during therapy, once a week for one month after radiotherapy completion, every 3 months for the first year and from then on every six months. In particular lung toxicity was investigated in terms of CT density evaluation, pulmonary functional tests, and clinical and radiological scoring. Paired t-test, Chi-square test and non-parametric Wilcoxon test were performed.
After a median follow-up of 43 months (range 36-52 months), all the patients are alive and disease-free. None of the patients showed any clinical signs of lung toxicity, no CT-lung toxicity was denoted by radiologist on CT lung images acquired about 1 year post-radiotherapy, no variation of pulmonary density evaluated in terms of normalised Hounsfield numbers was evident. Barely palpable increased density of the treated breast was noted in 9 out of 39 patients (in 2 patients this toxicity was limited to the boost area) and teleangectasia (<1/cm2) limited to the boost area was evident in 2 out of 39 patients. The compliance with the treatment was excellent (100%).
The radiotherapy schedule investigated in this study (i.e 34 Gy in 3.4 Gy/fr plus boost dose of 8 Gy in single fraction) is a feasible and safe treatment and does not lead to adjunctive acute and late toxicities. A longer follow up is necessary to confirm these favourable results.
加速部分乳房放疗是辅助全乳放疗的一种有吸引力的方法。在这项研究中，我们评估了至少在加速部分乳房放疗方案完成后 3 年的不良反应。
从 2004 年 10 月至 2006 年 3 月，连续 39 例年龄超过 18 岁的 pTis、pT1-2、pN0-1 乳腺腺癌患者接受了保乳手术后，采用加速部分乳房放疗方案治疗，包括 34 Gy 在 10 个每日分次中，2 周内完成全乳房放疗，1 周后用单剂量 8 Gy 电子束对肿瘤床进行局部加量。在治疗期间每天评估皮肤和肺部放射毒性，在放疗完成后 1 个月内每周评估一次，第 1 年内每 3 个月评估一次，从那时起每 6 个月评估一次。特别是在放射治疗后 1 年左右进行了 CT 密度评估、肺功能检查、临床和放射学评分，以评估肺毒性。进行了配对 t 检验、卡方检验和非参数 Wilcoxon 检验。
中位随访时间为 43 个月（范围 36-52 个月），所有患者均存活且无疾病。没有患者出现任何肺部毒性的临床症状，放射科医生在放射治疗后约 1 年的 CT 肺部图像上未发现 CT 肺部毒性，正常化的 Hounsfield 数值未显示出肺部密度的变化。39 例患者中有 9 例（2 例仅限于加量区）出现治疗侧乳房可触及的轻度密度增高，39 例患者中有 2 例（仅限于加量区）出现 1/cm2 以下的皮肤毛细血管扩张。治疗的依从性非常好（100%）。
本研究中研究的放疗方案（即 34 Gy 分 3.4 Gy/fr 加 8 Gy 单次分剂量加量）是一种可行且安全的治疗方法，不会导致附加的急性和迟发性毒性。需要更长的随访时间来确认这些有利的结果。
