Department of Radiation and Cellular Oncology, University of Chicago Hospitals, Chicago, IL.
Am J Clin Oncol. 2014 Aug;37(4):322-6. doi: 10.1097/COC.0b013e31827b45b7.
To compare the acute toxicity of hypofractionated whole breast radiotherapy (HypoRT) to conventionally fractionated radiotherapy (ConvRT) in large-breasted women with early stage disease.
Women with breast volume>1500 cm, body mass index>30 kg/m, or separation>25 cm treated with HypoRT or ConvRT from 2005 through 2010 were identified from a prospective database and included in the analysis. Acute toxicity was scored for each treated breast.
Ninety-two patients were treated to 96 breasts. The median body mass index was 33 kg/m and median breast volume was 1932 cm for the ConvRT group compared with 32.4 kg/m and 1825 cm for the HypoRT group. Maximum acute skin toxicity consisted of focal moist desquamation in 26% and 11% of the ConvRT and HypoRT patients, respectively (P=0.002). Breast volume was the only patient factor significantly associated with moist desquamation on multivariable analysis (P=0.01). Among those with a breast volume >2500 cm, focal moist desquamation occurred in 40.7% (11/27) compared with 11.1% (7/63) in patients with breast volume <2500 cm (P=0.002).
Among obese and large-breasted women, there was no increase in acute skin toxicity with the use of HypoRT. HypoRT should be considered in obese and large-breasted women when advanced planning techniques are used.
比较大乳房早期疾病患者采用HypoRT 与 ConvRT 进行全乳腺放射治疗的急性毒性。
从 2005 年至 2010 年，从前瞻性数据库中确定了接受 HypoRT 或 ConvRT 治疗的乳房体积>1500cm、体质量指数>30kg/m、或间隔>25cm 的女性，并将其纳入分析。对每个治疗乳房进行急性毒性评分。
92 例患者共 96 个乳房接受治疗。ConvRT 组的平均体质量指数为 33kg/m，乳房体积为 1932cm，而 HypoRT 组的平均体质量指数为 32.4kg/m，乳房体积为 1825cm。最大急性皮肤毒性包括焦点性湿性脱屑，ConvRT 和 HypoRT 患者中分别为 26%和 11%（P=0.002）。多变量分析显示，乳房体积是唯一与湿性脱屑显著相关的患者因素（P=0.01）。在乳房体积>2500cm 的患者中，40.7%（11/27）发生焦点性湿性脱屑，而乳房体积<2500cm 的患者中仅为 11.1%（7/63）（P=0.002）。
在肥胖和大乳房女性中，使用 HypoRT 并没有增加急性皮肤毒性。当使用先进的规划技术时，HypoRT 应考虑在肥胖和大乳房女性中使用。
