Department of Radiation Oncology, Rhode Island Hospital, Brown Alpert Medical School, Providence, RI; Department of Radiation Oncology, Tufts Medical Center, Tufts University School of Medicine, Boston, MA.
Clin Breast Cancer. 2013 Dec;13(6):455-9. doi: 10.1016/j.clbc.2013.08.005. Epub 2013 Oct 4.
To compare clinical outcomes and toxicity in patients treated with NIBB boost with those in patients treated with external beam (EB) boost.
Women with early stage breast cancer treated with WBI and NIBB boost were identified. Control subjects treated with EB boost identified as the best possible match with respect to age, stage, chemotherapy use, and fractionation were chosen for a 2:1 comparison. Acute toxicity, late toxicity, and oncologic outcomes were reviewed. The McNemar nonparametric test was used to evaluate marginal homogeneity between matched pairs.
One hundred forty-one patients were included in the analysis: 47 patients treated with NIBB boost and 94 matched control subjects treated with EB boost (electron, n = 93) or 3-D conformal radiation (n = 1). Grade 2+ desquamation developed in 18 patients (39%) treated with NIBB boost and in 49 patients (52%) treated with EB boost (P = .07). Breast size, electron energy, and fractionation predicted for acute desquamation (P < .0001, P < .001, and P = .006). Median follow-up was 13.6 months. One patient (2%) who received NIBB had Grade 2+ skin/subcutaneous fibrosis 15 months after completion of treatment. Among those treated with EB, 9 patients (9.5%) developed Grade 2+ subcutaneous fibrosis, and 1 patient had recurrent cellulitis. There was statistically significantly less combined skin/subcutaneous toxicity in those treated with NIBB than in those treated with EB (P = .046).
NIBB boost is associated with favorable short-term clinical outcomes compared with EB.
比较接受 NIBB 推量治疗和接受外照射（EB）推量治疗的患者的临床结果和毒性。
确定了接受 WBI 和 NIBB 推量治疗的早期乳腺癌女性患者。选择与年龄、分期、化疗使用和分割方式尽可能匹配的接受 EB 推量治疗的对照患者进行 2:1 比较。回顾急性毒性、晚期毒性和肿瘤学结果。使用 McNemar 非参数检验评估匹配对之间的边缘同质性。
141 例患者纳入分析：47 例接受 NIBB 推量治疗，94 例匹配的对照患者接受 EB 推量治疗（电子，n=93 例；或 3-D 适形放疗，n=1 例）。18 例（39%）接受 NIBB 推量治疗的患者和 49 例（52%）接受 EB 推量治疗的患者出现 2+ 级脱皮（P=0.07）。乳房大小、电子能量和分割方式预测急性脱皮（P<0.0001、P<0.001 和 P=0.006）。中位随访时间为 13.6 个月。1 例（2%）接受 NIBB 治疗的患者在治疗完成后 15 个月出现 2+ 级皮肤/皮下纤维化。在接受 EB 治疗的患者中，9 例（9.5%）出现 2+ 级皮下纤维化，1 例出现复发性蜂窝织炎。接受 NIBB 治疗的患者皮肤/皮下联合毒性显著低于接受 EB 治疗的患者（P=0.046）。
与 EB 相比，NIBB 推量治疗具有良好的短期临床结果。
