Department of Radiotherapy Physics, Mount Vernon Cancer Centre, Northwood, UK.
Br J Radiol. 2012 Sep;85(1017):e647-53. doi: 10.1259/bjr/32249628. Epub 2012 Jan 31.
The FAST (FASTer radiotherapy for breast radiotherapy) trial is a UK Phase 2 multicentre randomised clinical trial evaluating a five-fraction schedule of whole-breast radiotherapy following local excision of early breast cancer. The purpose of this quality assurance study was to analyse the radiotherapy planning data in order to confirm compliance with the trial protocol.
915 patients were recruited between 2004 and 2007 from 18 centres. The protocol required that all centres should use three-dimensional dose compensations to optimise radiotherapy plans. Planning techniques, maximum dose (D(max)) and dose-volume histograms from treatment plans were evaluated and compared between centres. The homogeneity of plans was tested by creating a cut-off value of 5% for the percentage of breast volume receiving >105% of the prescribed dose.
672 data sets from 15 centres were available. 93% (624/672) of plans were treated using forward-planned multileaf collimator (MLC) segments, 6% with breast compensators and 1% with inverse-planned MLC segments. 94% (635/672) of patients had a D(max)≤107% of the prescribed dose. 11% (74/672) of plans delivered >105% of the prescribed dose to >5% of the breast volume.
Reviewing the data in this study, 95% of plans submitted by centres complied with the protocol. With the improved breast radiotherapy standards shown in FAST centres, the following recommendations were suggested for future UK breast radiotherapy trials: (i) the minimum, mean and maximum dose to the whole-breast planning target volume (PTV) should be recorded and assessed; (ii) apart from having a D(max)≤107% of the prescribed dose, ≤5% of PTV should a receive dose >105% of the prescription dose.
FAST（FASTer 乳腺癌放疗）试验是一项英国的 2 期多中心随机临床试验，旨在评估局部切除早期乳腺癌后采用 5 个疗程的全乳放疗方案。本质量保证研究的目的是分析放射治疗计划数据，以确认是否符合试验方案。
2004 年至 2007 年期间，来自 18 个中心的 915 例患者被纳入该试验。该方案要求所有中心都应使用三维剂量补偿来优化放疗计划。评估并比较了各中心的计划技术、最大剂量（D（max））和剂量-体积直方图。通过创建一个 5%的截止值，即乳房体积的 5%接受了超过处方剂量 105%的剂量，来测试计划的均匀性。
来自 15 个中心的 672 个数据集可用。93%（624/672）的计划采用正向规划多叶准直器（MLC）段进行治疗，6%的计划采用乳房补偿器，1%的计划采用逆向规划 MLC 段。94%（635/672）的患者 D（max）≤处方剂量的 107%。11%（74/672）的计划向>5%的乳房体积输送了超过处方剂量 105%的剂量。
通过对本研究中的数据进行审查，95%的中心提交的计划符合方案要求。随着 FAST 中心放射治疗标准的提高，对未来英国乳腺癌放射治疗试验提出了以下建议：（i）应记录和评估整个乳房计划靶区（PTV）的最小、平均和最大剂量；（ii）除了 D（max）≤处方剂量的 107%外，≤5%的 PTV 应接受处方剂量的 105%以上的剂量。
