Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, PA 19111, USA.
Int J Radiat Oncol Biol Phys. 2012 Nov 15;84(4):881-7. doi: 10.1016/j.ijrobp.2012.01.069. Epub 2012 Aug 18.
To report the 5-year outcomes using whole-breast intensity-modulated radiation therapy (IMRT) for the treatment of early-stage-breast cancer at the Fox Chase Cancer Center.
A total of 946 women with early-stage breast cancer (stage 0, I, or II) were treated with IMRT after surgery with or without systemic therapy from 2003-2010. Whole-breast radiation was delivered via an IMRT technique with a median whole-breast radiation dose of 46 Gy and median tumor bed boost of 14 Gy. Endpoints included local-regional recurrence, cosmesis, and late complications.
With a median follow-up of 31 months (range, 1-97 months), there were 12 ipsilateral breast tumor recurrences (IBTR) and one locoregional recurrence. The 5-year actuarial IBTR and locoregional recurrence rates were 2.0% and 2.4%. Physician-reported cosmestic outcomes were available for 645 patients: 63% were considered "excellent", 33% "good", and <1.5% "fair/poor". For physician-reported cosmesis, boost doses≥16 Gy, breast size>900 cc, or boost volumes>34 cc were significantly associated with a "fair/poor" cosmetic outcome. Fibrosis, edema, erythema, and telangectasia were also associated with "fair/poor" physician-reported cosmesis; erythema and telangectasia remained significant on multivariate analysis. Patient-reported cosmesis was available for 548 patients, and 33%, 50%, and 17% of patients reported "excellent", "good", and "fair/poor" cosmesis, respectively. The use of a boost and increased boost volume: breast volume ratio were significantly associated with "fair/poor" outcomes. No parameter for patient-reported cosmesis was significant on multivariate analysis. The chances of experiencing a treatment related effect was significantly associated with a boost dose≥16 Gy, receipt of chemotherapy and endocrine therapy, large breast size, and electron boost energy.
Whole-breast IMRT is associated with very low rates of local recurrence at 5 years, 83%-98% "good/excellent" cosmetic outcomes, and minimal chronic toxicity, including late fibrosis.
报道使用全乳强度调制放射治疗（IMRT）治疗 Fox Chase 癌症中心早期乳腺癌的 5 年结果。
2003 年至 2010 年，共 946 例早期乳腺癌（0 期、I 期或 II 期）女性患者在手术后接受了 IMRT 治疗，包括或不包括全身治疗。全乳照射采用 IMRT 技术进行，全乳照射剂量中位数为 46Gy，肿瘤床推量中位数为 14Gy。终点包括局部区域复发、美容效果和迟发性并发症。
中位随访 31 个月（范围 1-97 个月），有 12 例同侧乳房肿瘤复发（IBTR）和 1 例局部区域复发。5 年局部区域无复发生存率和局部区域复发率分别为 2.0%和 2.4%。645 例患者可获得医师报告的美容效果：63%被认为“优秀”，33%“良好”，<1.5%“一般/差”。对于医师报告的美容效果，剂量≥16Gy 的推量、乳房大小>900cc 或推量体积>34cc 与“一般/差”的美容效果显著相关。纤维化、水肿、红斑和毛细血管扩张也与医师报告的“一般/差”美容效果相关；在多变量分析中，红斑和毛细血管扩张仍然有意义。548 例患者可获得患者报告的美容效果，分别有 33%、50%和 17%的患者报告“优秀”、“良好”和“一般/差”的美容效果。使用推量和增加推量体积/乳房体积比与“一般/差”结果显著相关。在多变量分析中，患者报告的美容效果的任何参数均无统计学意义。治疗相关效应的几率与剂量≥16Gy 的推量、接受化疗和内分泌治疗、乳房较大和电子束能量显著相关。
全乳 IMRT 治疗与 5 年局部复发率非常低（<2.0%）、83%-98%的“良好/优秀”美容效果和最小的慢性毒性相关，包括迟发性纤维化。
