Shin Samuel Minkee, No Hyun Soo, Vega Raymond Mailhot, Fenton-Kerimian Maria, Maisonet Olivier, Hitchen Christine, Keith DeWyngaert J, Formenti Silvia Chiara
Department of Radiation Oncology, New York University School of Medicine and Langone Medical Center, New York, New York.
Department of Radiation Oncology, New York Weill Cornell Medical Center, New York, New York.
Pract Radiat Oncol. 2016 Jul-Aug;6(4):e81-e88. doi: 10.1016/j.prro.2015.10.022. Epub 2015 Nov 9.
To test clinical feasibility, safety, and toxicity of prone hypofractionated breast, chest wall, and nodal radiation therapy.
Following either segmental or total mastectomy with axillary node dissection, patients were treated in an institutional review board-approved prospective trial of prone radiation therapy to the breast, chest wall, and supraclavicular and level III axillary lymph nodes. A dose of 40.5 Gy/15 fractions with a concomitant daily boost to the tumor bed of 0.5 Gy (total dose, 48 Gy) was prescribed. In postmastectomy patients, the same treatment was prescribed, but without a tumor bed boost. The primary endpoint was incidence of >grade 2 acute skin toxicity. The secondary endpoints were feasibility of treatment using prone set-up, compliance with protocol-defined dosimetric constraints, and incidence of late toxicity. A dosimetric comparison was performed between protocol plans (prone) and nonprotocol plans (supine), targeting the same treatment volumes.
Sixty-nine patients with stage IB-IIIA breast cancer enrolled in this trial. Surgery was segmental mastectomy (n = 45), mastectomy (n = 23), and bilateral mastectomy (n = 1), resulting in 70 cases. None experienced >grade 2 acute skin toxicity according to the Common Terminology Criteria for Adverse Events, v 3.0, meeting our primary endpoint. Ninety-six percent of patients could be treated with this technique prone. However, 17 plans (24%) exceeded protocol constraints to the brachial plexus. Maximum long-term toxicity was 1 grade 2 arm lymphedema, 1 grade 3 breast retraction, and no occurrence of brachial plexopathy. Dosimetric comparison of protocol with nonprotocol plans demonstrated significantly decreased lung and heart doses in prone plans.
Prone hypofractionated breast, chest wall, and nodal radiation therapy is safe and well tolerated in this study. Although the initial pattern of local and regional control is encouraging, longer follow-up is warranted for efficacy and late toxicity assessment, particularly to the brachial plexus.
测试俯卧位大分割乳腺、胸壁及淋巴结放射治疗的临床可行性、安全性和毒性。
在接受保乳手术或全乳切除并腋窝淋巴结清扫术后，患者参加了一项经机构审查委员会批准的前瞻性试验，该试验采用俯卧位对乳腺、胸壁、锁骨上及Ⅲ级腋窝淋巴结进行放射治疗。处方剂量为40.5 Gy分15次给予，同时每天对瘤床追加0.5 Gy（总剂量48 Gy）。在乳房切除术后患者中，给予相同治疗，但不追加瘤床剂量。主要终点是2级以上急性皮肤毒性的发生率。次要终点是使用俯卧位设置进行治疗的可行性、是否符合方案定义的剂量学限制以及晚期毒性的发生率。对针对相同治疗体积的方案计划（俯卧位）和非方案计划（仰卧位）进行了剂量学比较。
69例ⅠB-ⅢA期乳腺癌患者参加了本试验。手术方式为保乳手术（n = 45）、乳房切除术（n = 23）和双侧乳房切除术（n = 1），共70例。根据不良事件通用术语标准第3.0版，无一例发生2级以上急性皮肤毒性，达到了我们的主要终点。96%的患者可以采用这种俯卧位技术进行治疗。然而，17个计划（24%）超出了方案对臂丛神经的限制。最大长期毒性为1例2级手臂淋巴水肿、1例3级乳腺回缩，未发生臂丛神经病变。方案计划与非方案计划的剂量学比较表明，俯卧位计划中肺和心脏的剂量显著降低。
在本研究中，俯卧位大分割乳腺、胸壁及淋巴结放射治疗是安全的且耐受性良好。尽管局部和区域控制的初步模式令人鼓舞，但仍需要更长时间的随访来评估疗效和晚期毒性，特别是对臂丛神经的影响。
