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不可切除复发性乳腺癌再程放疗联合热疗后的局部控制率:248例患者的结果

Local control rate after the combination of re-irradiation and hyperthermia for irresectable recurrent breast cancer: Results in 248 patients.

作者信息

Linthorst Marianne, Baaijens Margreet, Wiggenraad Ruud, Creutzberg Carien, Ghidey Wendimagegn, van Rhoon Gerard C, van der Zee Jacoba

机构信息

Department of Radiation Oncology, Hyperthermia Unit, Erasmus MC Cancer Institute, Rotterdam, The Netherlands.

Department of Radiation Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands.

出版信息

Radiother Oncol. 2015 Nov;117(2):217-22. doi: 10.1016/j.radonc.2015.04.019. Epub 2015 May 19.

Abstract

BACKGROUND AND PURPOSE

Randomized studies have shown that adding hyperthermia (HT) to re-irradiation (re-RT) improves treatment outcome for patients with breast cancer recurrences. We evaluated the efficacy and side effects in patients treated with re-RT and HT for irresectable locoregional breast cancer recurrences.

MATERIAL AND METHODS

From September 1996 to December 2011, 248 patients with a macroscopic breast cancer recurrence were treated with re-RT and HT. Radiotherapy (RT) was applied to a dose of 32 Gy in 4 Gy fractions, twice weekly. HT was prescribed once weekly after RT. Primary endpoints for this analysis were complete response (CR) and local control (LC). Secondary endpoints were overall survival (OS), and toxicity. Patient-, tumor-, and treatment-related characteristics predictive for the endpoints were identified in univariate and multivariate analyses.

RESULTS

The median follow-up period was 32 months. The CR rate was 70%. At 1, 3, and 5 years LC was 53%, 40% and 39%, and OS was 66%, 32%, and 18%, respectively. OS after 10 years was 10%. Thermal burns developed in 23% patients, healing with conservative measures. The incidence of 5 years late grade 3 toxicity was 1%. A few patients survived more than 10 years without evidence of disease.

CONCLUSIONS

The combination of re-RT and HT results in a high rate of long-term LC with acceptable late toxicity, and many patients remained locally controlled for the rest of their survival period.

摘要

背景与目的

随机研究表明,在再程放疗(re-RT)中加入热疗(HT)可改善乳腺癌复发患者的治疗效果。我们评估了接受再程放疗和热疗治疗不可切除的局部区域乳腺癌复发患者的疗效和副作用。

材料与方法

1996年9月至2011年12月,248例肉眼可见乳腺癌复发患者接受了再程放疗和热疗。放疗剂量为32 Gy,分4 Gy 每次,每周两次。热疗在放疗后每周进行一次。该分析的主要终点是完全缓解(CR)和局部控制(LC)。次要终点是总生存期(OS)和毒性。在单变量和多变量分析中确定了对终点有预测作用的患者、肿瘤和治疗相关特征。

结果

中位随访期为32个月。完全缓解率为70%。1年、3年和5年时局部控制率分别为53%、40%和39%,总生存率分别为66%、32%和18%。10年后总生存率为10%。23%的患者发生了热烧伤,经保守治疗愈合。5年迟发性3级毒性发生率为1%。少数患者存活超过10年且无疾病证据。

结论

再程放疗和热疗相结合可实现较高的长期局部控制率,且迟发性毒性可接受,许多患者在余生中保持局部控制。

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