Kaidar-Person Orit, Kostich Mark, Zagar Timothy M, Jones Ellen, Gupta Gaorav, Mavroidis Panayiotis, Das Shiva K, Marks Lawrence B
Department of Radiation Oncology, University of North Carolina, USA.
Department of Radiation Oncology, University of North Carolina, USA.
Breast. 2016 Aug;28:79-83. doi: 10.1016/j.breast.2016.05.004. Epub 2016 May 30.
We report our initial clinical experience with using Helical tomotherapy to irradiate the bilateral breasts/chest-wall and regional nodes.
The records of patients who received bilateral irradiation of the breast/chest-wall and regional nodes with tomotherapy were retrospectively reviewed. Clinical outcomes for tumor and normal tissues were assessed.
From August 2011 to January 2016, nine women were identified; median age 52 years (range 37-74), mean follow up was 10.3 months (range 0.3-34). In two patients, tomotherapy represented re-irradiation to one side. All received regional nodal irradiation. The average lung V20 was 29% (range 25-35), average lung V5 was 66% (range 51-75). Average heart mean dose was 20 Gy (range 13-28).
Acute toxicity during radiation included dysphagia (5/9), fatigue (4/9), nausea and weight loss (1/9) and skin desquamation (9/9). Two patients were lost to long follow-up and one patient recently completed treatment. Longer-term toxicity included: pneumonitis (1/6), elevated liver function tests (1/6) and sternal osteonecrosis (1/6; in patient with prior sternal surgery).
Despite the small numbers of patients and relatively short follow-up, significant clinical toxicities were observed. Given the rarity of this situation and relatively high rate of complications in this small series, considerable care should be taken in minimizing dose to normal structures. Longer follow up with larger numbers of patients will be needed to establish safe dosimetric parameters for bilateral breasts/chest wall and nodal irradiation with tomotherapy.
我们报告了使用螺旋断层放疗技术对双侧乳房/胸壁及区域淋巴结进行照射的初步临床经验。
回顾性分析接受断层放疗双侧乳房/胸壁及区域淋巴结照射患者的记录。评估肿瘤和正常组织的临床结局。
2011年8月至2016年1月，共纳入9名女性患者；中位年龄52岁（范围37 - 74岁），平均随访时间为10.3个月（范围0.3 - 34个月）。2例患者为对一侧进行再次照射。所有患者均接受区域淋巴结照射。平均肺V20为29%（范围25% - 35%），平均肺V5为66%（范围51% - 75%）。平均心脏平均剂量为20 Gy（范围13 - 28 Gy）。
放疗期间的急性毒性反应包括吞咽困难（5/9）、疲劳（4/9）、恶心和体重减轻（1/9）以及皮肤脱屑（9/9）。2例患者失访，1例患者近期完成治疗。长期毒性反应包括：肺炎（1/6）、肝功能检查异常（1/6）和胸骨骨坏死（1/6；该患者曾接受胸骨手术）。
尽管患者数量较少且随访时间相对较短，但仍观察到显著的临床毒性反应。鉴于这种情况罕见且本小样本系列中的并发症发生率相对较高，在尽量减少对正常结构的剂量时应格外谨慎。需要对更多患者进行更长时间的随访，以确定螺旋断层放疗双侧乳房/胸壁及淋巴结照射的安全剂量参数。
