Department of Radiation Oncology, New York University School of Medicine and Langone Medical Center, New York, NY 10016, USA.
Int J Radiat Oncol Biol Phys. 2012 Nov 1;84(3):606-11. doi: 10.1016/j.ijrobp.2012.01.039. Epub 2012 Apr 9.
To report the 5-year results of a prospective trial of three-dimensional conformal external beam radiotherapy (3D-CRT) to deliver accelerated partial breast irradiation in the prone position.
Postmenopausal patients with Stage I breast cancer with nonpalpable tumors <2 cm, negative margins and negative nodes, positive hormone receptors, and no extensive intraductal component were eligible. The trial was offered only after eligible patients had refused to undergo standard whole-breast radiotherapy. Patients were simulated and treated on a dedicated table for prone setup. 3D-CRT was delivered at a dose of 30 Gy in five 6-Gy/day fractions over 10 days with port film verification at each treatment. Rates of ipsilateral breast failure, ipsilateral nodal failure, contralateral breast failure, and distant failure were estimated using the cumulative incidence method. Rates of disease-free, overall, and cancer-specific survival were recorded.
One hundred patients were enrolled in this institutional review board-approved prospective trial, one with bilateral breast cancer. One patient withdrew consent after simulation, and another patient elected to interrupt radiotherapy after receiving two treatments. Ninety-eight patients were evaluable for toxicity, and, in 1 case, both breasts were treated with partial breast irradiation. Median patient age was 68 years (range, 53-88 years); in 55% of patients the tumor size was <1 cm. All patients had hormone receptor-positive cancers: 87% of patients underwent adjuvant antihormone therapy. At a median follow-up of 64 months (range, 2-125 months), there was one local recurrence (1% ipsilateral breast failure) and one contralateral breast cancer (1% contralateral breast failure). There were no deaths due to breast cancer by 5 years. Grade 3 late toxicities occurred in 2 patients (one breast edema, one transient breast pain). Cosmesis was rated good/excellent in 89% of patients with at least 36 months follow-up.
Five-year efficacy and toxicity of 3D-CRT delivered in prone partial breast irradiation are comparable to other experiences with similar follow-up.
报告一项前瞻性试验的 5 年结果，该试验采用三维适形外照射放疗（3D-CRT）在俯卧位进行加速部分乳房照射。
患有 Stage I 乳腺癌的绝经后患者，肿瘤不可触及<2cm，切缘阴性且无淋巴结转移，激素受体阳性，无广泛的导管内成分。该试验仅在符合条件的患者拒绝接受标准全乳放疗后提供。患者在专用俯卧位治疗台上进行模拟和治疗。3D-CRT 以 30Gy 的剂量分 5 次给予，每次 6Gy，每天 1 次，每次治疗时均进行端口膜验证。使用累积发生率法估计同侧乳房失败、同侧淋巴结失败、对侧乳房失败和远处失败的发生率。记录无病生存率、总生存率和癌症特异性生存率。
该机构审查委员会批准的前瞻性试验共纳入 100 例患者，其中 1 例为双侧乳腺癌。1 例患者在模拟后撤回同意，另 1 例患者在接受 2 次治疗后选择中断放疗。98 例患者可评估毒性，其中 1 例患者双侧乳房均接受部分乳房照射。中位患者年龄为 68 岁（范围，53-88 岁）；55%的肿瘤直径<1cm。所有患者的癌症均为激素受体阳性：87%的患者接受了辅助激素治疗。中位随访时间为 64 个月（范围，2-125 个月），有 1 例局部复发（同侧乳房失败 1%）和 1 例对侧乳腺癌（对侧乳房失败 1%）。5 年内无乳腺癌死亡。2 例患者发生 3 级晚期毒性（1 例乳房水肿，1 例短暂性乳房疼痛）。至少随访 36 个月的 89%患者的美容效果评为良好/优秀。
在俯卧位进行部分乳房照射的 3D-CRT 的 5 年疗效和毒性与其他具有类似随访的经验相当。
