Department of Radiation Oncology, William Beaumont Hospital, Royal Oak, Michigan 48073, USA.
Int J Radiat Oncol Biol Phys. 2011 Nov 1;81(3):788-94. doi: 10.1016/j.ijrobp.2010.06.062. Epub 2010 Oct 8.
We analyzed variables associated with long-term toxicity using three-dimensional conformal external beam radiation therapy (3D-CRT) to deliver accelerated partial breast irradiation.
One hundred patients treated with 3D-CRT accelerated partial breast irradiation were evaluated using Common Terminology Criteria for Adverse Events version 4.0 scale. Cosmesis was scored using Harvard criteria. Multiple dosimetric and volumetric parameters were analyzed for their association with worst and last (W/L) toxicity outcomes.
Sixty-two patients had a minimum of 36 months of toxicity follow-up (median follow-up, 4.8 years). The W/L incidence of poor-fair cosmesis, any telangiectasia, and grade ≥2 induration, volume reduction, and pain were 16.4%/11.5%, 24.2%/14.5%, 16.1%/9.7%, 17.7%/12.9%, and 11.3%/3.2%, respectively. Only the incidence of any telangiectasia was found to be predicted by any dosimetric parameter, with the absolute breast volume receiving 5% to 50% of the prescription dose (192.5 cGy-1925 cGy) being significant. No associations with maximum dose, volumes of lumpectomy cavity, breast, modified planning target volume, and PTV, dose homogeneity index, number of fields, and photon energy used were identified with any of the aforementioned toxicities. Non-upper outer quadrant location was associated with grade ≥2 volume reduction (p = 0.02 W/p = 0.04 L). A small cavity-to-skin distance was associated with a grade ≥2 induration (p = 0.03 W/p = 0.01 L), a borderline significant association with grade ≥2 volume reduction (p = 0.06 W/p = 0.06 L) and poor-fair cosmesis (p = 0.08 W/p = 0.09 L), with threshold distances ranging from 5 to 8 mm.
No dose--volume relationships associated with long-term toxicity were identified in this large patient cohort with extended follow-up. Cosmetic results were good-to-excellent in 88% of patients at 5 years.
我们分析了使用三维适形外照射放疗（3D-CRT）进行加速部分乳房照射的长期毒性相关变量。
使用通用不良事件术语标准 4.0 版对 100 例接受 3D-CRT 加速部分乳房照射的患者进行评估。采用哈佛标准对美容效果进行评分。分析了多种剂量学和体积参数与最差和最后（W/L）毒性结果的关系。
62 例患者的毒性随访时间至少为 36 个月（中位随访时间为 4.8 年）。差-可的美容效果、任何毛细血管扩张症和 2 级以上硬结、体积缩小和疼痛的 W/L 发生率分别为 16.4%/11.5%、24.2%/14.5%、16.1%/9.7%、17.7%/12.9%和 11.3%/3.2%。仅发现任何毛细血管扩张症的发生率与任何剂量学参数有关，其中接受处方剂量 5%至 50%的绝对乳房体积（192.5cGy-1925cGy）具有显著意义。与最大剂量、肿块腔、乳房、改良计划靶区和 PTV、剂量均匀性指数、射野数量和使用的光子能量等任何上述毒性均无相关性。非外上象限位置与 2 级以上体积缩小有关（p=0.02 W/p=0.04 L）。小的腔-皮肤距离与 2 级以上硬结相关（p=0.03 W/p=0.01 L），与 2 级以上体积缩小和差-可美容效果呈边缘显著相关（p=0.06 W/p=0.06 L 和 p=0.08 W/p=0.09 L），阈值距离范围为 5 至 8mm。
在这项具有长期随访的大型患者队列中，没有发现与长期毒性相关的剂量-体积关系。5 年时，88%的患者美容效果良好至优秀。
