Ciammella Patrizia, Podgornii Ala, Galeandro Maria, Micera Renato, Ramundo Dafne, Palmieri Tamara, Cagni Elisabetta, Iotti Cinzia
Radiation Oncology Unit, Department of Advanced Technology, Arcispedale Santa Maria Nuova, Istituto di Ricovero e Cura a Carattere Scientifico, Viale Risorgimento 80, 42123 Reggio Emilia Italy.
Radiat Oncol. 2014 Apr 24;9:97. doi: 10.1186/1748-717X-9-97.
The objective of this study is to evaluate toxicity and cosmetic outcome in breast cancer patients treated with adjuvant hypo fractionated radiotherapy to the whole breast, and to identify the risk factors for toxicity.
Two hundred twelve women with early breast cancer underwent conserving surgery were enrolled in the study. The patients received 40.05 Gy in 15 daily fractions, 2.67 Gy per fraction. The boost to the tumor bed was administered with a total dose of 9 Gy in 3 consecutive fractions in 55 women. Physician-rated acute and late toxicity and cosmetic outcome (both subjective and objective) were prospectively assessed during and after radiotherapy.
In our population study the mean age was 63 with the 17% (36 pts) of the women younger than 50 years.The median follow-up was 34 months. By the end of RT, 35 patients out of 212 (16%) no acute toxicity, according to the RTOG criteria, while 145 (68%) and 31 patients (15%) developed grade 1 and grade 2 acute skin toxicity, respectively.Late skin toxicity evaluation was available for all 212 patients with a minimum follow up of 8 months. The distribution of toxicity was: 39 pts (18%) with grade 1 and 2 pts (1%) with grade 2. No worse late skin toxicity was observed.Late subcutaneous grade 0-1 toxicity was recorded in 208 patients (98%) and grade 2 toxicity in 3 patients (2%), while grade 3 was observed in 1 patient only. At last follow up, a subjective and objective good or excellent cosmetic outcome was reported in 93% and 92% of the women, respectively. At univariate and multivariate analysis, the late skin toxicity was correlated with the additional boost delivery (p=0.007 and p=0.023). Regarding the late subcutaneous tissue, a correlation with diabetes was found (p=0.0283).
These results confirm the feasibility and safety of the hypofractionated radiotherapy in patients with early breast cancer. In our population the boost administration was resulted to be a significant adverse prognostic factor for acute and late toxicity. Long-term follow up is need to confirm this finding.
本研究的目的是评估接受全乳辅助低分割放疗的乳腺癌患者的毒性和美容效果，并确定毒性的危险因素。
212例接受保乳手术的早期乳腺癌女性纳入本研究。患者接受15次每日分割照射，总剂量40.05 Gy，每次分割剂量2.67 Gy。55例患者对瘤床进行推量照射，连续3次分割，总剂量9 Gy。放疗期间及放疗后前瞻性评估医生评定的急性和晚期毒性以及美容效果（主观和客观）。
在我们的人群研究中，平均年龄为63岁，17%（36例）女性年龄小于50岁。中位随访时间为34个月。放疗结束时，根据RTOG标准，212例患者中有35例（16%）无急性毒性，145例（68%）和31例（15%）分别出现1级和2级急性皮肤毒性。对所有212例患者进行了晚期皮肤毒性评估，最短随访时间为8个月。毒性分布为：39例（18%）为1级，2例（1%）为2级。未观察到更严重的晚期皮肤毒性。208例患者（98%）记录有晚期皮下0-1级毒性，3例患者（2%）为2级毒性，仅1例患者观察到3级毒性。在最后随访时，分别有93%和92%的女性报告主观和客观美容效果良好或优秀。单因素和多因素分析显示，晚期皮肤毒性与额外的推量照射相关（p=0.007和p=0.023）。关于晚期皮下组织，发现与糖尿病相关（p=0.0283）。
这些结果证实了早期乳腺癌患者低分割放疗的可行性和安全性。在我们的人群中，推量照射是急性和晚期毒性的一个重要不良预后因素。需要长期随访来证实这一发现。
