Sanz J, Rodríguez N, Foro P, Dengra J, Reig A, Pérez P, Membrive I, Ortiz A, Codinach M, Algara M
Radiation Oncology Department, Hospital de l'Esperança, Parc de Salut Mar, Avinguda Sant Josep de la Muntanya 12, 08024, Barcelona, Spain.
Radiation Oncology Research Group, Institut Municipal d'Investigació Médica (IMIM), Doctor Aiguader, 88, 08003, Barcelona, Spain.
Clin Transl Oncol. 2017 Apr;19(4):464-469. doi: 10.1007/s12094-016-1548-3. Epub 2016 Sep 21.
To evaluate the impact of hypofractionated boost after hypofractionated whole breast irradiation in breast carcinoma.
Patients after breast conservative surgery were treated all time with hypofractionation of 2.67 Gy/day. Whole breast dose was 40.05 Gy followed in case of risk of local relapse by a boost of 16.02 Gy or 8.01 Gy. Acute and chronic toxicity results were evaluated including cosmetic software-assisted assessment and objective evaluation of fibrosis parameters (elasticity and hydration) by means of a skin tester.
A total of 362 patients were evaluated. Acute toxicities comprised grade 1 dermatitis in 48.1 %, grade 2 in 44.5 % and grade 3 in 17 patients 4.7 %, respectively. After a median follow-up of 4.5 years, in 308 cases (86.6 %) there was no chronic skin or subcutaneous changes. In the first consecutive 50 patients, measures with skin tester showed no statistical differences in parameters for skin and subcutaneous fibrosis. Cosmetic results were considered excellent and good in 26 and 62 %, respectively.
Boost to tumour bed with hypofractionated doses is well tolerated and acute and chronic toxicities are mild with good cosmetic results. Objective systems are encouraging methods to assess skin quality and cosmesis.
评估乳腺癌大分割全乳照射后大分割推量照射的影响。
保乳手术后的患者均接受每日2.67 Gy的大分割治疗。全乳剂量为40.05 Gy，若有局部复发风险，则追加16.02 Gy或8.01 Gy的推量照射。评估急性和慢性毒性结果，包括使用美容软件辅助评估以及通过皮肤测试仪对纤维化参数（弹性和水合作用）进行客观评估。
共评估了362例患者。急性毒性反应中，48.1%为1级皮炎，44.5%为2级，17例（4.7%）为3级。中位随访4.5年后，308例（86.6%）无慢性皮肤或皮下改变。在最初连续的50例患者中，皮肤测试仪测量结果显示皮肤和皮下纤维化参数无统计学差异。美容效果方面，分别有26%和62%被评为优秀和良好。
大分割剂量对瘤床的推量照射耐受性良好，急慢性毒性反应轻微，美容效果良好。客观评估系统是评估皮肤质量和美容效果很有前景的方法。
