Nakamura Naoki, Arahira Satoko, Zenda Sadamoto, Yoneyama Kimiyasu, Mukai Hirofumi, Onozawa Masakatsu, Toshima Masamichi, Motegi Atsushi, Hirano Yasuhiro, Hojo Hidehiro, Kibe Yuichi, Akimoto Tetsuo
Division of Radiation Oncology, National Cancer Center Hospital East, 6-5-1, Kashiwanoha, Kashiwa, Chiba 277-8577, Japan
Division of Radiation Oncology, National Cancer Center Hospital East, 6-5-1, Kashiwanoha, Kashiwa, Chiba 277-8577, Japan.
J Radiat Res. 2017 Jan;58(1):66-70. doi: 10.1093/jrr/rrw055. Epub 2016 Jul 15.
To clarify the efficacy and toxicity of post-mastectomy radiation therapy (PMRT) without usage of a bolus, we identified 129 consecutive patients who received PMRT at the National Cancer Center Hospital East between 2003 and 2012. Seven of the 129 patients who received breast reconstruction before PMRT were excluded. All patients received PMRT of 6 MV photons, without usage of a bolus. The median follow-up duration for all eligible patients was 47.7 months (range: 4.0-123.2). Local, locoregional and isolated locoregional recurrence was found in 12 (9.8%), 14 (11%) and 5 patients (4.1%), respectively. The 3- and 5-year cumulative incidence of local recurrence, locoregional recurrence and isolated locoregional recurrence was 9.2 and 10.7%, 10.8 and 12.4%, and 4.3 and 4.3%, respectively. Although Grade 2 dermatitis was found in 11 patients (9.0%), no Grade 3-4 dermatitis was found. On univariate analysis, only a non-luminal subtype was a significant predictor for local recurrence (P < 0.001). On multivariate analysis, a non-luminal subtype remained as an independent predictor for local recurrence (P = 0.003, odds ratio: 10.9, 95% confidence interval: 2.23-53.1). In conclusion, PMRT without usage of a bolus resulted in a low rate of severe acute dermatitis without an apparent increase in local recurrence. PMRT without usage of a bolus may be reasonable, especially for patients with a luminal subtype.
为阐明不使用填充物的乳房切除术后放射治疗（PMRT）的疗效和毒性，我们纳入了2003年至2012年间在国立癌症中心东医院接受PMRT的129例连续患者。在PMRT前接受乳房重建的129例患者中有7例被排除。所有患者均接受6 MV光子的PMRT，不使用填充物。所有符合条件患者的中位随访时间为47.7个月（范围：4.0 - 123.2个月）。局部、区域和孤立区域复发分别见于12例（9.8%）、14例（11%）和5例（4.1%）患者。局部复发、区域复发和孤立区域复发的3年和5年累积发生率分别为9.2%和10.7%、10.8%和12.4%、4.3%和4.3%。虽然11例患者（9.0%）出现2级皮炎，但未发现3 - 4级皮炎。单因素分析显示，仅非管腔亚型是局部复发的显著预测因素（P < 0.001）。多因素分析显示，非管腔亚型仍是局部复发的独立预测因素（P = 0.003，比值比：10.9，95%置信区间：2.23 - 53.1）。总之，不使用填充物的PMRT导致严重急性皮炎发生率低，且局部复发无明显增加。不使用填充物的PMRT可能是合理的，尤其是对于管腔亚型患者。
