队列分析以确定早期乳腺癌术中放疗（IORT）的合适患者。
A cohort analysis to identify eligible patients for intraoperative radiotherapy (IORT) of early breast cancer.
机构信息
Department of Radiation Oncology, University Medical Center Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, Mannheim, 68167, Germany.
出版信息
Radiat Oncol. 2014 Jul 12;9:154. doi: 10.1186/1748-717X-9-154.
BACKGROUND
Since the results from the randomized TARGIT A trial were published, intraoperative radiotherapy (IORT) is used more often. IORT can be provided as accelerated partial breast irradiation (APBI) or as a boost. The definition of suitable patients for IORT as APBI differs between different national societies (e.g. ESTRO and ASTRO) and different inclusion criteria of trials and so does the eligibility of patients. This analysis identifies eligible patients for IORT according to available consensus statements and inclusion criteria of the ongoing TARGIT trials.
METHODS
Between 01/03 - 12/09, 1505 breast cancer cases were treated at the breast cancer center at the University Medical Center Mannheim. Complete data sets for age, stage (T, N, and M), histology and hormone receptor status were available in 1108 cases. Parameters to identify eligible patients are as follows: ESTRO: >50 years, invasive ductal carcinoma/other favorable histology (IDC), T1-2 (≤3 cm), N0, any hormone receptor status, M0; ASTRO: ≥60 years, IDC, T1, N0, positive estrogen hormone receptor status, M0; TARGIT E "elderly", risk adapted radiotherapy with IORT followed by external beam radiotherapy in case of risk factors in final histopathology, phase II: ≥70 years, IDC, T1, N0, any hormone receptor status, M0; TARGIT C "consolidation", risk adapted radiotherapy, phase IV: ≥50 years, IDC, T1, N0, positive hormone receptor status, M0; TARGIT BQR "boost quality registry": every age, every histology, T1-2 (max. 3.5 cm), any hormone receptor status, N0/+, M0/+.
RESULTS
Out of the 1108 cases, 379 cases (34.2%) were suitable for IORT as APBI regarding the ESTRO and 175 (15.8%) regarding the ASTRO consensus statements. 82 (7.4%) patients were eligible for the TARGIT E trial, 258 (23.3%) for the TARGIT C trial and 671 (60.6%) for the TARGIT BQR registry. According to the consensus statements of ASTRO (45.1%) and ESTRO (41.4%) about half of the eligible patients were treated with IORT as APBI. From the eligible patients fulfilling the criteria for IORT boost (35%) about one third was eventually treated.
CONCLUSIONS
Patient selection for IORT should be restrictive. For IORT as APBI the TARGIT trials are even more restrictive including patients than the ESTRO and ASTRO consensus statements.
背景
自从 TARGIT A 试验的结果公布后，术中放疗（IORT）的应用越来越多。IORT 可以作为加速部分乳房照射（APBI）或作为辅助治疗。不同的国家学会（如 ESTRO 和 ASTRO）和不同的试验纳入标准对 IORT 作为 APBI 的适用患者的定义不同，患者的资格也不同。本分析根据现有的共识声明和正在进行的 TARGIT 试验的纳入标准，确定适合 IORT 的患者。
方法
在 2013 年 3 月至 2019 年 9 月期间，有 1505 例乳腺癌患者在曼海姆大学医学中心的乳腺癌中心接受治疗。在 1108 例患者中，有完整的年龄、分期（T、N 和 M）、组织学和激素受体状态的数据。确定适合患者的参数如下：ESTRO：>50 岁，浸润性导管癌/其他有利的组织学（IDC），T1-2（≤3cm），N0，任何激素受体状态，M0；ASTRO：≥60 岁，IDC，T1，N0，阳性雌激素受体状态，M0；TARGIT E“老年”，风险适应放疗伴 IORT，如有危险因素则在最终组织病理学中进行外照射放疗，Ⅱ期：≥70 岁，IDC，T1，N0，任何激素受体状态，M0；TARGIT C“巩固”，风险适应放疗，Ⅳ期：≥50 岁，IDC，T1，N0，阳性激素受体状态，M0；TARGIT BQR“质量提升注册”：任何年龄，任何组织学，T1-2（最大 3.5cm），任何激素受体状态，N0/+，M0/+。
结果
在 1108 例患者中，有 379 例（34.2%）符合 ESTRO 共识声明和 175 例（15.8%）符合 ASTRO 共识声明，适合 IORT 作为 APBI。82 例（7.4%）患者符合 TARGIT E 试验的标准，258 例（23.3%）符合 TARGIT C 试验的标准，671 例（60.6%）符合 TARGIT BQR 登记的标准。根据 ASTRO（45.1%）和 ESTRO（41.4%）的共识声明，大约一半的合格患者接受了 IORT 作为 APBI 治疗。在符合 IORT 增强标准的合格患者中（35%），最终约有三分之一接受了治疗。
结论
IORT 的患者选择应严格限制。对于 IORT 作为 APBI，TARGIT 试验比 ESTRO 和 ASTRO 共识声明更严格地纳入了患者。
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