Ahlawat Stuti, Haffty Bruce G, Goyal Sharad, Kearney Thomas, Kirstein Laurie, Chen Chunxia, Moore Dirk F, Khan Atif J
Rutgers Cancer Institute of New Jersey, New Jersey.
Rutgers School of Public Health, Piscataway, New Jersey.
Int J Radiat Oncol Biol Phys. 2016 Jan 1;94(1):118-125. doi: 10.1016/j.ijrobp.2015.09.011. Epub 2015 Sep 16.
Conventionally fractionated whole-breast irradiation (WBI) with a boost takes approximately 6 to 7 weeks. We evaluated a short course of hypofractionated (HF), accelerated WBI in which therapy was completed in 3 weeks inclusive of a sequential boost.
We delivered a whole-breast dose of 36.63 Gy in 11 fractions of 3.33 Gy over 11 days, followed by a lumpectomy bed boost in 4 fractions of 3.33 Gy delivered once daily for a total of 15 treatment days. Acute toxicities were scored using Common Terminology Criteria for Adverse Events version 4. Late toxicities were scored using the Radiation Therapy Oncology Group/European Organization for Research and Treatment of Cancer scale. Cosmesis was scored using the Harvard Cosmesis Scale. Our primary endpoint was freedom from locoregional failure; we incorporated early stopping criteria based on predefined toxicity thresholds. Cosmesis was examined as a secondary endpoint.
We enrolled 83 women with stages 0 to IIIa breast cancer. After a median follow-up of 40 months, 2 cases of isolated ipsilateral breast tumor recurrence occurred (2 of 83; crude rate, 2.4%). Three-year estimated local recurrence-free survival was 95.9% (95% confidence interval [CI]: 87.8%-98.7%). The 3-year estimated distant recurrence-free survival was 97.3% (95% CI: 89.8%-99.3%). Three-year secondary malignancy-free survival was 94.3% (95% CI: 85.3%-97.8%). Twenty-nine patients (34%) had grade 2 acute toxicity, and 1 patient had a late grade 2 toxicity (fibrosis). One patient had acute grade 3 dermatitis, whereas 2 patients experienced grade 3 late skin toxicity. Ninety-four percent of evaluable patients had good or excellent cosmesis.
Our phase 2 institutional study offers one of the shortest courses of HF therapy, delivered in 15 fractions inclusive of a sequential boost. We demonstrated expected low toxicity and high local control rates with good to excellent cosmetic outcomes. This fractionation scheme is feasible and well tolerated and offers women WBI in a highly convenient schedule.
传统的全乳照射（WBI）并追加剂量大约需要6至7周。我们评估了一种短疗程的大分割（HF）加速WBI方案，该方案在3周内完成治疗，包括序贯追加剂量。
我们在11天内分11次给予全乳剂量36.63 Gy，每次3.33 Gy，随后对肿块切除床分4次给予3.33 Gy的追加剂量，每天1次，总共15个治疗日。使用不良事件通用术语标准第4版对急性毒性进行评分。使用放射肿瘤学组/欧洲癌症研究与治疗组织量表对晚期毒性进行评分。使用哈佛美容量表对美容效果进行评分。我们的主要终点是无局部区域复发；我们纳入了基于预定义毒性阈值的早期终止标准。将美容效果作为次要终点进行检查。
我们纳入了83例0至IIIa期乳腺癌女性患者。中位随访40个月后，发生2例孤立性同侧乳腺肿瘤复发（83例中的2例；粗发病率，2.4%）。三年估计局部无复发生存率为95.9%（95%置信区间[CI]：87.8%-98.7%）。三年估计远处无复发生存率为97.3%（95% CI：89.8%-99.3%）。三年无第二原发恶性肿瘤生存率为94.3%（95% CI：85.3%-97.8%）。29例患者（34%）出现2级急性毒性，1例患者出现晚期2级毒性（纤维化）。1例患者出现3级急性皮炎，2例患者出现3级晚期皮肤毒性。94%的可评估患者美容效果良好或极佳。
我们的2期机构研究提供了最短疗程之一的HF治疗方案，共15次分割，包括序贯追加剂量。我们证明了预期的低毒性和高局部控制率，美容效果良好至极佳。这种分割方案可行且耐受性良好，为女性提供了非常方便的WBI治疗方案。
