Bourgier C, Pichenot C, Verstraet R, Heymann S, Biron B, Balleyguier C, Delaloge S, Mathieu M-C, Uzan C, Garbay J-R, Bourhis J, Taghian A, Marsiglia H
Département d'oncologie-radiothérapie, institut Gustave-Roussy, 39, rue Camille-Desmoulins, 94800 Villejuif, France.
Cancer Radiother. 2010 Dec;14(8):718-26. doi: 10.1016/j.canrad.2010.05.006. Epub 2010 Jul 31.
Since 2009, accelerated partial breast irradiation (APBI) in North America has been allowed to be used for selected group of patients outside a clinical trial according to the ASTRO consensus statement. In France, accelerated partial breast irradiation is still considered investigational, several clinical trials have been conducted using either intraoperative (Montpellier) or Mammosite(®) (Lille) or brachytherapy modality (PAC GERICO/FNCLCC). Here, we report the original dosimetric results of this technique.
Since October 2007, Institut Gustave-Roussy has initiated a phase II trial using 3D-conformal accelerated partial breast irradiation (40 Gy in 10 fractions BID in 1 week). Twenty-five patients with pT1N0 breast cancer were enrolled and were treated by two minitangent photons beams (6MV) and an "en face" electron beam (6-22 MeV).
The mean clinical target volume and planning target volume were respectively 15.1cm(3) (range: 5.2-28.7 cm(3)) and 117 cm(3) (range: 52-185 cm(3)). The planning target volume coverage was adequate with at least a mean of 99% of the volume encompassed by the isodose 40 Gy. The mean dose to the planning target volume was 41.8 Gy (range: 41-42.4 Gy). Dose inhomogeneity did not exceed 5%. Mean doses to the ipsilateral lung and heart were 1.6 Gy (range: 1.0-2.3 Gy) and 1.2 Gy (range: 1.0-1.6 Gy), respectively.
The 3D conformal accelerated partial breast irradiation using two minitangent and "en face" electron beams using a total dose of 40 Gy in 10 fractions BID over 5 days achieves appropriate planning target volume coverage and offers significant normal-tissue sparing (heart, lung). Longer follow-up is needed to evaluate the tissue tolerance to this radiation dose.
自2009年起，根据美国放射肿瘤学会（ASTRO）的共识声明，北美地区允许在临床试验之外对特定患者群体使用加速部分乳腺照射（APBI）。在法国，加速部分乳腺照射仍被视为试验性治疗，已经开展了多项临床试验，采用术中放疗（蒙彼利埃）、Mammosite®（里尔）或近距离放疗模式（PAC GERICO/FNCLCC）。在此，我们报告该技术的原始剂量学结果。
自2007年10月起，古斯塔夫 - 鲁西研究所启动了一项II期试验，采用三维适形加速部分乳腺照射（1周内分10次，每次2次，共40 Gy）。纳入了25例pT1N0乳腺癌患者，采用两束小切线光子束（6MV）和一束“正面”电子束（6 - 22 MeV）进行治疗。
平均临床靶体积和计划靶体积分别为15.1cm³（范围：5.2 - 28.7 cm³）和117 cm³（范围：52 - 185 cm³）。计划靶体积覆盖率足够，至少40 Gy等剂量线所包含体积的平均覆盖率为99%。计划靶体积的平均剂量为41.8 Gy（范围：41 - 42.4 Gy）。剂量不均匀性不超过5%。同侧肺和心脏的平均剂量分别为1.6 Gy（范围：1.0 - 2.3 Gy）和1.2 Gy（范围：1.0 - 1.6 Gy）。
使用两束小切线和“正面”电子束，在5天内分10次，每次2次给予总剂量40 Gy的三维适形加速部分乳腺照射，可实现适当的计划靶体积覆盖，并显著减少正常组织（心脏、肺）受照剂量。需要更长时间的随访来评估该辐射剂量下的组织耐受性。
