Oldenborg Sabine, Griesdoorn Vanessa, van Os Rob, Kusumanto Yoka H, Oei Bing S, Venselaar Jack L, Zum Vörde Sive Vörding Paul J, Heymans Martijn W, Kolff Merel Willemijn, Rasch Coen R N, Crezee Hans, van Tienhoven Geertjan
Department of Radiation Oncology, Academic Medical Center, University of Amsterdam (AMC), The Netherlands.
Department of Radiation Oncology, Academic Medical Center, University of Amsterdam (AMC), The Netherlands.
Radiother Oncol. 2015 Nov;117(2):223-8. doi: 10.1016/j.radonc.2015.10.017. Epub 2015 Nov 2.
BACKGROUND/PURPOSE: Treatment options for irresectable locoregional recurrent breast cancer in previously irradiated area are limited. Hyperthermia, elevating tumor temperature to 40-45°C, sensitizes radio-and-chemotherapy. Four hundred and fourteen patients treated with reirradiation+hyperthermia (reRT+HT) in the AMC(n=301) and the BVI(n=113), from 1982 to 2005 were retrospectively analyzed for treatment response, locoregional control (LC) and prognostic factors for LC and toxicity.
PATIENTS/METHODS: All patients received previous irradiation (median 50 Gy). reRT consisted of 8 × 4 Gy-2/week (AMC) or 12 × 3 Gy-4/week (BVI). Hyperthermia was added once (AMC)/twice (BVI) a week.
Overall clinical response rate was 86%. The 3-year LC rate was 25%. The number of recurrence episodes, distant metastases (DM), tumor site, tumor size, time to recurrence and treatment year were significant for LC. Acute ⩾ grade 3 toxicity occurred in 24% of patients. Actuarial late ⩾ grade 3 toxicity was 23% at 3-years. In multivariable analysis reRT fraction dose was significantly related to late ⩾ grade 3 toxicity.
reRT+HT is an effective curative and palliative treatment option for patients with irresectable locoregional recurrent breast cancer in previously irradiated area. Early referral, treatment of chest wall recurrences ⩽ 5 cm in the absence of distant metastases, provided the highest local control rates. The cumulative effects of past and present treatments should be accounted for by adjusting treatment protocol to minimize toxicity.
背景/目的：对于先前接受过放疗区域内不可切除的局部区域性复发性乳腺癌，治疗选择有限。热疗将肿瘤温度升高至40 - 45°C，可使放疗和化疗更敏感。对1982年至2005年在AMC（n = 301）和BVI（n = 113）接受再程放疗+热疗（reRT + HT）的414例患者进行回顾性分析，以评估治疗反应、局部区域控制（LC）以及LC和毒性的预后因素。
患者/方法：所有患者均接受过先前的放疗（中位剂量50 Gy）。再程放疗方案为每周2次，每次4 Gy，共8次（AMC）或每周4次，每次3 Gy，共12次（BVI）。热疗每周进行1次（AMC）/2次（BVI）。
总体临床缓解率为86%。3年局部区域控制率为25%。复发次数、远处转移（DM）、肿瘤部位、肿瘤大小、复发时间和治疗年份对局部区域控制有显著影响。24%的患者发生急性≥3级毒性反应。3年时精算晚期≥3级毒性反应发生率为23%。多变量分析显示，再程放疗分次剂量与晚期≥3级毒性反应显著相关。
再程放疗+热疗是先前接受过放疗区域内不可切除的局部区域性复发性乳腺癌患者有效的根治性和姑息性治疗选择。早期转诊，在无远处转移的情况下治疗胸壁复发灶≤5 cm，可获得最高的局部控制率。应通过调整治疗方案来考虑既往和当前治疗的累积效应，以尽量减少毒性。
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