Department of Radiation Oncology, Baptist Hospital of Miami, Miami, FL, USA.
Int J Radiat Oncol Biol Phys. 2012 Apr 1;82(5):2104-10. doi: 10.1016/j.ijrobp.2011.02.024. Epub 2011 Jun 2.
To report the feasibility, toxicity, cosmesis, and efficacy of using intensity-modulated radiation therapy (IMRT) with respiratory gating to deliver accelerated partial breast irradiation (APBI) in selected Stage I/II breast cancer after breast-conserving surgery.
Eligible patients with node-negative Stage I/II breast cancer were prospectively enrolled in an institutional review board approved protocol to receive APBI using IMRT after breast-conserving surgery. The target volume was treated at 3.8 Gy/fraction twice daily for 5 days, to a total dose of 38 Gy.
Thirty-six patients were enrolled for a median follow-up time of 44.8 months. The median tumor size was 0.98 cm (range, 0.08-3 cm). The median clinical target volume (CTV) treated was 71.4 cc (range, 19-231 cc), with the mean dose to the CTV being 38.96 Gy. Acute toxicities included Grade 1 erythema in 44% of patients and Grade 2 in 6%, Grade 1 hyperpigmentation in 31% of patients and Grade 2 in 3%, and Grade 1 breast/chest wall tenderness in 14% of patients. No Grade 3/4 acute toxicities were observed. Grade 1 and 2 late toxicities as edema, fibrosis, and residual hyperpigmentation occurred in 14% and 11% of patients, respectively; Grade 3 telangiectasis was observed in 3% of patients. The overall cosmetic outcome was considered "excellent" or "good" by 94% of patients and 97% when rated by the physician, respectively. The local control rate was 97%; 1 patient died of a non-cancer-related cause.
APBI can be safely and effectively administered using IMRT. In retrospective analysis, IMRT enabled the achievement of normal tissue dose constraints as outlined by Radiation Therapy Oncology Group 04-13/NSABP B-13 while providing excellent conformality for the CTV. Local control and cosmesis have remained excellent at current follow-up, with acceptable rates of acute/late toxicities. Our data suggest that cosmesis is dependent on target volume size. Further prospective multi-institutional trials should be performed to evaluate IMRT to deliver APBI.
报告在保乳手术后使用带呼吸门控的调强放疗（IMRT）给予选定的 I 期/II 期乳腺癌患者加速部分乳腺照射（APBI）的可行性、毒性、美容效果和疗效。
符合条件的无淋巴结转移的 I 期/II 期乳腺癌患者前瞻性地参与了一项机构审查委员会批准的方案，在保乳手术后接受 IMRT 行 APBI。靶区以 3.8 Gy/分次，每日 2 次，共 5 天，总剂量 38 Gy。
36 例患者入组，中位随访时间为 44.8 个月。中位肿瘤大小为 0.98 cm（范围，0.08-3 cm）。中位临床靶区（CTV）治疗体积为 71.4 cc（范围，19-231 cc），CTV 平均剂量为 38.96 Gy。急性毒性包括 44%的患者出现 1 级红斑和 6%的 2 级红斑，31%的患者出现 1 级色素沉着和 3%的 2 级色素沉着，14%的患者出现 1 级乳房/胸壁触痛。未观察到 3/4 级急性毒性。14%和 11%的患者分别出现 1 级和 2 级晚期毒性，包括水肿、纤维化和残留色素沉着，3%的患者出现 3 级毛细血管扩张。94%的患者认为美容效果“优秀”或“良好”，分别有 97%的患者和医生认为美容效果“优秀”或“良好”。局部控制率为 97%；1 例患者死于非癌症相关原因。
APBI 可安全有效地使用 IMRT 进行。在回顾性分析中，IMRT 使正常组织剂量限制达到放射治疗肿瘤学组 04-13/NSABP B-13 的要求，同时为 CTV 提供了极好的适形性。在目前的随访中，局部控制和美容效果仍然很好，急性/晚期毒性发生率可接受。我们的数据表明，美容效果取决于靶区体积。应进行进一步的前瞻性多机构试验，以评估 IMRT 用于 APBI。
