Radiotherapy and radiosurgery, Humanitas Cancer Center, Istituto Clinico Humanitas, Rozzano, Milano, Italy.
Radiat Oncol. 2012 Aug 28;7:145. doi: 10.1186/1748-717X-7-145.
To report results in terms of feasibility and early toxicity of hypofractionated simultaneous integrated boost (SIB) approach with Volumetric Modulated Arc Therapy (VMAT) as adjuvant treatment after breast-conserving surgery.
Between September 2010 and May 2011, 50 consecutive patients presenting early-stage breast cancer were submitted to adjuvant radiotherapy with SIB-VMAT approach using RapidArc in our Institution (Istituto Clinico Humanitas ICH). Three out of 50 patients were irradiated bilaterally (53 tumours in 50 patients). All patients were enrolled in a phase I-II trial approved by the ICH ethical committee. All 50 patients enrolled in the study underwent VMAT-SIB technique to irradiate the whole breast with concomitant boost irradiation of the tumor bed. Doses to whole breast and surgical bed were 40.5 Gy and 48 Gy respectively, delivered in 15 fractions over 3 weeks. Skin toxicities were recorded during and after treatment according to RTOG acute radiation morbidity scoring criteria with a median follow-up of 12 months (range 8-16). Cosmetic outcomes were assessed as excellent/good or fair/poor.
The median age of the population was 68 years (range 36-88). According to AJCC staging system, 38 breast lesions were classified as pT1, and 15 as pT2; 49 cases were assessed as N0 and 4 as N1. The maximum acute skin toxicity by the end of treatment was Grade 0 in 20/50 patients, Grade 1 in 32/50, Grade 2 in 0 and Grade 3 in 1/50 (one of the 3 cases of bilateral breast irradiation). No Grade 4 toxicities were observed. All Grade 1 toxicities had resolved within 3 weeks. No significant differences in cosmetic scores on baseline assessment vs. 3 months and 6 months after the treatment were observed: all patients were scored as excellent/good (50/50) compared with baseline; no fair/poor judgment was recorded. No other toxicities or local failures were recorded during follow-up.
The 3-week course of postoperative radiation using VMAT with SIB showed to be feasible and was associated with acceptable acute skin toxicity profile. Long-term follow-up data are needed to assess late toxicity and clinical outcomes.
报告采用容积调强弧形治疗（VMAT）的适形调强同步推量（SIB）作为保乳手术后辅助治疗的可行性和早期毒性结果。
2010 年 9 月至 2011 年 5 月，50 例早期乳腺癌患者在我们机构（ICH）接受 SIB-VMAT 辅助放疗。其中 3 例为双侧照射（50 例患者中有 53 个肿瘤）。所有患者均在 ICH 伦理委员会批准的 I 期-Ⅱ期试验中入组。所有 50 例患者均接受 VMAT-SIB 技术照射全乳，同时对肿瘤床进行推量照射。全乳和手术床的剂量分别为 40.5Gy 和 48Gy，在 3 周内分 15 次给予。根据 RTOG 急性放射损伤评分标准，在治疗期间和治疗后记录皮肤毒性，中位随访时间为 12 个月（8-16 个月）。根据美容效果评估为优/良或差/可。
患者的中位年龄为 68 岁（36-88 岁）。根据 AJCC 分期系统，38 例乳腺病变为 pT1，15 例为 pT2；49 例为 N0，4 例为 N1。治疗结束时，皮肤急性毒性最大的为 20/50 例为 0 级，32/50 例为 1 级，0 例为 2 级，1/50 例（3 例双侧乳腺照射中有 1 例）为 3 级。未观察到 4 级毒性。所有 1 级毒性均在 3 周内缓解。治疗后 3 个月和 6 个月与基线评估相比，美容评分无显著差异：所有患者（50/50）均与基线评分一致，均为优/良；无差/可判断。随访期间未记录其他毒性或局部失败。
采用 VMAT 的 SIB 进行 3 周术后放疗是可行的，且皮肤急性毒性可接受。需要长期随访数据来评估晚期毒性和临床结果。
