Department of Radiotherapy, National Institute of Oncology, Mohammed V University, Rabat, Morocco.
Department of Radiotherapy, National Institute of Oncology, Mohammed V University, Rabat, Morocco.
Int J Radiat Oncol Biol Phys. 2017 Mar 1;97(3):563-570. doi: 10.1016/j.ijrobp.2016.11.010. Epub 2016 Nov 15.
To evaluate the effect of hypofractionated radiation therapy (HFRT) of the breast/chest wall and regional nodes on overall survival (OS), disease-free survival (DFS), locoregional control and on treatment-related toxicity in patients with breast cancer and nodal involvement.
Two hundred fifty-seven patients treated between October 2009 and June 2011 with hypofractionated locoregional radiation therapy (42 Gy in 15 fractions) were retrospectively reviewed, 51 (19.8%) after breast-conserving surgery and 206 (80.2%) after radical surgery. Patients treated with breast-conserving surgery received a boost dose to the tumor bed (delivered by photons, electrons, or interstitial high-dose-rate brachytherapy). Two hundred fifty-six (99.6%) patients underwent chemotherapy, 209 (81.3%) had hormonal treatment, and 65 (25.3%) had anti-HER2 targeted therapy.
The median follow-up time was 64 months (range, 11-88 months). The rates of 5-year OS, DFS, locoregional recurrence (LRR)-free survival, and distant metastasis (DM)-free survival were 86.6%, 84.4%, 93.9%, and 83.1%, respectively. In multivariate analysis (MVA), lymph node ratio >65%, lymphovascular invasion, and negative hormone receptor status predicted for OS, DSF, and DM. T3 to 4 stage was also associated with worse DFS and DM. Finally, for LRR the independent prognostic factors on MVA were N2 to 3 stage and grade 3. Hyperpigmentation was observed in 19.2% of patients, telangiectasia in 12.3%, and fibrosis in 30.7%. Grade ≥2 lymphedema was recorded in 5.8% of cases. During the study follow-up, no cardiac or symptomatic pneumonitis was observed, nor were plexopathy or rib fractures.
According to the findings from this retrospective study, HFRT seems to be an acceptable alternative for patients with breast cancer who need regional nodal irradiation. However, prospective randomized trials are necessary to confirm these preliminary results.
评估乳腺癌/胸壁和区域淋巴结的低分割放射治疗（HFRT）对伴有淋巴结转移的乳腺癌患者的总生存（OS）、无病生存（DFS）、局部区域控制以及治疗相关毒性的影响。
回顾性分析了 2009 年 10 月至 2011 年 6 月期间接受低分割局部区域放射治疗（42Gy 分 15 次）的 257 例患者，其中 51 例（19.8%）接受保乳手术，206 例（80.2%）接受根治性手术。接受保乳手术的患者接受肿瘤床的推量剂量（由光子、电子或间质高剂量率近距离放射治疗提供）。256 例（99.6%）患者接受化疗，209 例（81.3%）接受激素治疗，65 例（25.3%）接受抗 HER2 靶向治疗。
中位随访时间为 64 个月（范围，11-88 个月）。5 年 OS、DFS、局部区域无复发生存（LRR）和远处无转移生存（DM）率分别为 86.6%、84.4%、93.9%和 83.1%。多变量分析（MVA）显示，淋巴结比例>65%、脉管侵犯和阴性激素受体状态与 OS、DFS 和 DM 相关。T3 至 4 期与较差的 DFS 和 DM 相关。此外，对于 LRR，MVA 的独立预后因素为 N2 至 3 期和 3 级。19.2%的患者出现色素沉着过度，12.3%的患者出现毛细血管扩张，30.7%的患者出现纤维化。5.8%的病例记录到 2 级或以上的淋巴水肿。在研究随访期间，未观察到心脏或有症状的放射性肺炎，也未观察到神经丛病变或肋骨骨折。
根据这项回顾性研究的结果，HFRT 似乎是需要区域淋巴结照射的乳腺癌患者的一种可接受的替代治疗方法。然而，需要前瞻性随机试验来证实这些初步结果。
