Chang Ji Hyun, Lee Nam Kwon, Kim Ja Young, Kim Yeon-Joo, Moon Sung Ho, Kim Tae Hyun, Kim Joo-Young, Kim Dae Yong, Cho Kwan Ho, Shin Kyung Hwan
Proton Therapy Center, Research Institute and Hospital, National Cancer Center, Goyang, Republic of Korea; Department of Radiation Oncology, Seoul National University College of Medicine, Republic of Korea.
Radiother Oncol. 2013 Aug;108(2):209-14. doi: 10.1016/j.radonc.2013.06.008. Epub 2013 Jul 25.
Here, we report the results of our phase II, prospective study of proton beam accelerated partial breast irradiation (PB-APBI) in patients with breast cancer after breast conserving surgery (BCS).
Thirty patients diagnosed with breast cancer were treated with PB-APBI using a single-field proton beam or two fields after BCS. The treatment dose was 30 cobalt gray equivalent (CGE) in six CGE fractions delivered once daily over five consecutive working days.
All patients completed PB-APBI. The median follow-up time was 59 months (range: 43-70 months). Of the 30 patients, none had ipsilateral breast recurrence or regional or distant metastasis, and all were alive at the last follow-up. Physician-evaluated toxicities were mild to moderate, except in one patient who had severe wet desquamation at 2 months that was not observed beyond 6 months. Qualitative physician cosmetic assessments of good or excellent were noted in 83% and 80% of the patients at the end of PB-APBI and at 2 months, respectively, and decreased to 69% at 3 years. A good or excellent cosmetic outcome was noted in all patients treated with a two-field proton beam at any follow-up time point except for one. For all patients, the mean percentage breast retraction assessment (pBRA) value increased significantly during the follow-up period (p=0.02); however, it did not increase in patients treated with two-field PB-APBI (p=0.3).
PB-APBI consisting of 30 CGE in six CGE fractions once daily for five consecutive days can be delivered with excellent disease control and tolerable skin toxicity to properly selected patients with early-stage breast cancer. Multiple-field PB-APBI may achieve a high rate of good-to-excellent cosmetic outcomes. Additional clinical trials with larger patient groups are needed.
在此，我们报告保乳手术后乳腺癌患者接受质子束加速部分乳腺照射（PB-APBI）的II期前瞻性研究结果。
30例确诊为乳腺癌的患者在保乳手术后接受单野质子束或两野PB-APBI治疗。治疗剂量为30钴灰当量（CGE），分6次CGE剂量，连续5个工作日每天照射1次。
所有患者均完成PB-APBI。中位随访时间为59个月（范围：43 - 70个月）。30例患者中，无同侧乳腺复发、区域或远处转移，且在最后一次随访时均存活。医生评估的毒性为轻至中度，除1例患者在2个月时出现严重湿性脱皮，6个月后未再出现。在PB-APBI结束时和2个月时，分别有83%和80%的患者医生定性美容评估为良好或优秀，3年时降至69%。除1例患者外，所有接受两野质子束治疗的患者在任何随访时间点的美容效果均为良好或优秀。对于所有患者，随访期间平均乳腺回缩评估（pBRA）值显著增加（p = 0.02）；然而，接受两野PB-APBI治疗的患者该值未增加（p = 0.3）。
对于适当选择的早期乳腺癌患者，连续5天每天1次给予6次CGE共30 CGE的PB-APBI可实现良好的疾病控制和可耐受的皮肤毒性。多野PB-APBI可能实现高比例的良好至优秀美容效果。需要开展更大患者群体的额外临床试验。
