Mellon Eric A, Sreeraman Radhika, Gebhardt Brian J, Mierzejewski Aline, Correa Candace R
Department of Radiation Oncology, Moffitt Cancer Center, Tampa, Florida.
Department of Radiation Oncology, Moffitt Cancer Center, Tampa, Florida.
Pract Radiat Oncol. 2014 May-Jun;4(3):e159-e166. doi: 10.1016/j.prro.2013.08.001. Epub 2013 Oct 5.
There are concerns regarding cosmetic outcomes of 3-dimensional conformal accelerated partial breast radiation therapy (3DCRT APBI). Associations between cosmetic outcomes and treatment parameters or receipt of adjuvant systemic therapy were sought to guide 3DCRT APBI.
An analysis of cosmetic outcomes among patients treated with 3DCRT APBI at Moffitt Cancer Center was performed. Overall cosmesis was evaluated using modified Harvard criteria and toxicity outcomes were graded using National Cancer Institute Common Terminology Criteria for Adverse Events, version 3.0. Patients were treated to 38.5 Gy in 3.85 Gy twice daily fractions per dose-volume objectives specified in the National Surgical Adjuvant Breast and Bowel B-39/Radiation Therapy Oncology Group 0413 (NSABP B-39/RTOG 0413) trial.
At least 1 evaluation was available for 97 treated breasts (94 women) with median follow-up of 17.2 months (range, 1-60 months). Most breasts (90.7%) had grade 1 to 2 (excellent to good) overall cosmesis. Nine breasts (9.3%) had grade 3 to 4 (fair to poor) overall cosmesis, secondary to >25% asymmetry in 5 patients, grade 3 fibrosis in 3 patients, and fat necrosis in 1 patient. Increasing percentage of ipsilateral breast volume receiving more than 50% of the prescription dose (V50%) correlated with less than excellent cosmesis (P < .001), with a threshold V50% of 40%. Telangiectasia formation (6%) correlated with increased evaluation planning target volume (P = .006) and V50% (P = .017). Grade 2+ fibrosis (18%) and grade 1+ induration (83%) were also correlated with increasing V50% (P = .006 and .002, respectively). Smaller ipsilateral breast volume correlated with worsening cosmesis (P = .048) and induration (P = .028). Two of 4 patients receiving chemotherapy developed grade 3 fibrosis (P = .004) and fair/poor cosmesis (P = .04).
The current analysis implies that acceptable cosmetic results are achievable with 3DCRT APBI technique by adhering to optimal radiation therapy dose-volume constraints, particularly ipsilateral breast V50%.
人们对三维适形加速部分乳腺放疗（3DCRT APBI）的美容效果存在担忧。旨在寻找美容效果与治疗参数或辅助性全身治疗之间的关联，以指导3DCRT APBI治疗。
对莫菲特癌症中心接受3DCRT APBI治疗的患者的美容效果进行了分析。使用改良的哈佛标准评估总体美容效果，并根据美国国立癌症研究所不良事件通用术语标准3.0版对毒性结果进行分级。根据国立外科辅助乳腺和肠道项目B-39/放射治疗肿瘤学组0413（NSABP B-39/RTOG 0413）试验中规定的剂量体积目标，患者每天分两次接受3.85 Gy的照射，总剂量达38.5 Gy。
对97例接受治疗的乳房（94名女性）进行了至少1次评估，中位随访时间为17.2个月（范围1 - 60个月）。大多数乳房（90.7%）的总体美容效果为1至2级（优至良）。9例乳房（9.3%）的总体美容效果为3至4级（中至差），原因是5例患者的不对称超过25%，3例患者出现3级纤维化，1例患者出现脂肪坏死。同侧乳腺接受超过50%处方剂量的体积百分比（V50%）增加与美容效果不佳相关（P <.001），V50%的阈值为40%。毛细血管扩张形成（6%）与计划靶体积增加（P =.006）和V50%增加（P =.017）相关。2级及以上纤维化（18%）和1级及以上硬结（83%）也与V50%增加相关（分别为P =.006和.002）。同侧乳房体积较小与美容效果变差（P =.048）和硬结（P =.028）相关。4例接受化疗的患者中有2例出现3级纤维化（P =.004）和美容效果中/差（P =.04）。
目前的分析表明，通过遵循最佳放疗剂量体积限制，特别是同侧乳腺V50%，3DCRT APBI技术可实现可接受的美容效果。
