British Columbia Cancer Agency-Vancouver Island, Victoria, BC, Canada.
Int J Radiat Oncol Biol Phys. 2011 Dec 1;81(5):1220-7. doi: 10.1016/j.ijrobp.2010.07.2003. Epub 2010 Oct 23.
To report 3-year toxicity, cosmesis, and efficacy of a multicenter study of external beam, accelerated partial breast irradiation (APBI) for early-stage breast cancer.
Between March 2005 and August 2006, 127 women aged ≥40 years with ductal carcinoma in situ or node-negative invasive breast cancer ≤3 cm in diameter, treated with breast-conserving surgery achieving negative margins, were accrued to a prospective study involving five Canadian cancer centers. Women meeting predefined dose constraints were treated with APBI using 3 to 5 photon beams, delivering 35 to 38.5 Gy in 10 fractions, twice a day, over 1 week. Patients were assessed for treatment-related toxicities, cosmesis, and efficacy before APBI and at specified time points for as long as 3 years after APBI.
104 women had planning computed tomography scans showing visible seromas, met dosimetric constraints, and were treated with APBI to doses of 35 Gy (n=9), 36 Gy (n=33), or 38.5 Gy (n=62). Eighty-seven patients were evaluated with minimum 3-year follow-up after APBI. Radiation dermatitis, breast edema, breast induration, and fatigue decreased from baseline levels or stabilized by the 3-year follow-up. Hypopigmentation, hyperpigmentation, breast pain, and telangiectasia slightly increased from baseline levels. Most toxicities at 3 years were Grade 1. Only 1 patient had a Grade 3 toxicity with telangiectasia in a skin fold inside the 95% isodose. Cosmesis was good to excellent in 86% (89/104) of women at baseline and 82% (70/85) at 3 years. The 3-year disease-free survival was 97%, with only one local recurrence that occurred in a different quadrant away from the treated site and two distant recurrences.
At 3 years, toxicity and cosmesis were acceptable, and local control and disease-free survival were excellent, supporting continued accrual to randomized APBI trials.
报告一项多中心早期乳腺癌外照射加速部分乳房照射（APBI）的 3 年毒性、美容效果和疗效研究。
2005 年 3 月至 2006 年 8 月，127 名年龄≥40 岁的女性，患有导管原位癌或淋巴结阴性浸润性乳腺癌，直径≤3cm，保乳手术后切缘阴性，符合前瞻性研究的条件，涉及加拿大五个癌症中心。满足预设剂量限制的女性使用 3 至 5 束光子束，每天两次，1 周内共 10 次，每次 35 至 38.5Gy，进行 APBI 治疗。在 APBI 前和 APBI 后指定时间点，对患者进行与治疗相关的毒性、美容效果和疗效评估，最长可达 3 年。
104 名女性的计划计算机断层扫描（CT）显示可见的血清肿，符合剂量学限制，并接受了 35Gy（n=9）、36Gy（n=33）或 38.5Gy（n=62）的 APBI 治疗。87 名患者在 APBI 后至少有 3 年的随访。放射性皮炎、乳房水肿、乳房硬结和疲劳从基线水平或在 3 年随访时稳定下降。色素减退、色素沉着、乳房疼痛和毛细血管扩张从基线水平略有增加。3 年时的大多数毒性反应为 1 级。只有 1 名患者在 95%等剂量线内的皮肤褶皱处出现 3 级毒性反应，表现为毛细血管扩张。104 名女性中有 86%（89/104）在基线时有良好至极好的美容效果，82%（70/85）在 3 年时有良好至极好的美容效果。3 年无病生存率为 97%，仅发生 1 例局部复发，位于治疗部位以外的另一个象限，2 例远处复发。
3 年时，毒性和美容效果可接受，局部控制和无病生存率良好，支持继续招募 APBI 随机试验。
