老年乳腺癌患者行标准保乳治疗（BCT）是否合理？根据 CTC 分级的前瞻性急性毒性测量。

Is standard breast-conserving therapy (BCT) in elderly breast cancer patients justified? A prospective measurement of acute toxicity according CTC-classification.

机构信息

Paul Scherrer Institute, Villigen PSI, Switzerland.

出版信息

Radiat Oncol. 2010 Nov 4;5:103. doi: 10.1186/1748-717X-5-103.

DOI:10.1186/1748-717X-5-103

PMID:21050439

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC2987938/

Abstract

BACKGROUND

Breast conserving therapy (BCT) is an accepted treatment for early-stage breast cancer. This study aimed to measure prospectively acute radiation-related toxicity and to create a comprehensive data base for long-term temporal analyses of 3D conformal adjuvant radiotherapy. The specific aspect of age has been neglected by traditional research. Therefore, the impact of age on acute BCT toxicity should be also specifically addressed.

METHODS

Toxicity was measured in 109 patients at initiation (t1), during radiotherapy (t2-t7), and 6 weeks after treatment completion (t8) using a new topographic module. Organ systems were recorded in 15 scales and scored according to symptom intensity (grade 0-5) based on CTC (Common Toxicity Criteria) -classification. Radiotherapy was virtually CT-based planned and applied with 6-MeV-photons. Mean total dose was 60.1 Gy. Patients were stratified by age in 3 Groups: <50, 50-60, and >60 years.

RESULTS

Registered toxicity was generally low. Mean overall-grade climbed from 0.29-0.40 (t1-t7), and dropped to 0.23 (t8). Univariate analyses revealed slightly higher toxicity in older (> 60 years) versus young patients (< 50 years) in 2 scales only: breast-symmetry (p = 0.033), and arm function (p = 0.007). However, in the scale "appetite" toxicity was higher in younger (< 50 years) versus older (> 60 years) patients (p = 0.039). Toxicity differences in all other scales were not significant. Between older (> 60 years) and midaged patients (50-60 years) no significant differences in toxicity were found. This was also true for the comparison between young (< 50 years) versus midaged patient groups (50-60 years).

CONCLUSION

The treatment concept of BCT for breast cancer is generally well tolerated. The toxicity-measurement with the new topographic module is feasible. Not modified standard treatment for BC should be performed in elderly women.

摘要

背景

保乳治疗（BCT）是早期乳腺癌的一种公认的治疗方法。本研究旨在前瞻性地测量急性放射性相关毒性，并为 3D 适形辅助放疗的长期时间分析创建一个综合数据库。传统研究忽视了年龄这一特定方面。因此，还需要特别研究年龄对急性 BCT 毒性的影响。

方法

在治疗开始时（t1）、放疗期间（t2-t7）和治疗完成后 6 周（t8），使用新的地形模块对 109 名患者进行毒性测量。根据 CTC（常见毒性标准）分级，将器官系统记录在 15 个量表中，并根据症状强度（0-5 级）进行评分。放疗实际上是基于 CT 计划的，使用 6-MeV 光子进行治疗。总剂量平均为 60.1Gy。根据年龄将患者分为 3 组：<50 岁、50-60 岁和>60 岁。

结果

登记的毒性通常较低。总体等级从 0.29-0.40（t1-t7）上升，在 t8 时降至 0.23。单变量分析显示，在仅 2 个量表中，老年（>60 岁）患者的毒性略高于年轻患者（<50 岁）：乳房对称（p=0.033）和手臂功能（p=0.007）。然而，在“食欲”量表中，年轻（<50 岁）患者的毒性高于老年（>60 岁）患者（p=0.039）。在所有其他量表中，毒性差异无统计学意义。在老年（>60 岁）和中年（50-60 岁）患者之间，毒性无显著差异。年轻（<50 岁）与中年（50-60 岁）患者组之间的比较也是如此。