Sayan Mutlay, Wilson Karen, Nelson Carl, Gagne Havaleh, Rubin Deborah, Heimann Ruth
Department of Radiation Oncology, University of Vermont Medical Center, Burlington, VT, USA.
University of Vermont Cancer Center, Burlington, VT, USA.
Radiat Oncol J. 2017 Mar;35(1):32-38. doi: 10.3857/roj.2016.01963. Epub 2017 Feb 13.
Several accelerated partial breast radiation (APBR) techniques have been investigated in patients with early-stage breast cancer (BC); however, the optimal treatment delivery techniques remain unclear. We evaluated the feasibility and toxicity of APBR delivered using intensity-modulated radiation therapy (IMRT) in elderly patients with stage I BC, using a novel fractionation schedule.
Forty-two patients aged ≥65 years, with stage I BC who underwent breast conserving surgery were enrolled in a phase I/II study evaluating APBR using IMRT. Forty eligible patients received 40 Gy in 4 Gy daily fractions. Patients were assessed for treatment related toxicities, and cosmesis, before APBR, during, and after completion of the treatment.
The median age was 73 years, median tumor size 0.8 cm and the median follow-up was 54 months. The 5-year locoregional control was 97.5% and overall survival 90%. Erythema and skin pigmentation was the most common acute adverse event, reported by 27 patients (69%). Twenty-six patients (65%) reported mild pain, rated 1-4/10. This improved at last follow-up to only 2 (15%). Overall the patient and physician reported worst late toxicities were lower than the baseline and at last follow-up, patients and physicians rated cosmesis as excellent/good in 93% and 86 %, respectively.
In this prospective trial, we observed an excellent rate of tumor control with daily APBR. The acceptable toxicity profile and cosmetic results of this study support the use of IMRT planned APBR with daily schedule in elderly patients with early stage BC.
已对早期乳腺癌（BC）患者的几种加速局部乳腺放疗（APBR）技术进行了研究；然而，最佳的治疗实施技术仍不明确。我们采用一种新的分割方案，评估了调强放射治疗（IMRT）用于老年I期BC患者的APBR的可行性和毒性。
42例年龄≥65岁、接受保乳手术的I期BC患者纳入一项评估IMRT用于APBR的I/II期研究。40例符合条件的患者接受了40 Gy，每日分割剂量为4 Gy。在APBR前、治疗期间和治疗完成后，对患者进行治疗相关毒性和美容效果评估。
中位年龄为73岁，中位肿瘤大小为0.8 cm，中位随访时间为54个月。5年局部区域控制率为97.5%，总生存率为90%。红斑和皮肤色素沉着是最常见的急性不良事件，27例患者（69%）报告出现。26例患者（65%）报告轻度疼痛，疼痛评分为1 - 4/10。在最后一次随访时，这一比例仅改善至2例（15%）。总体而言，患者和医生报告的最严重晚期毒性低于基线水平，在最后一次随访时，患者和医生分别将美容效果评为优秀/良好的比例为93%和86%。
在这项前瞻性试验中，我们观察到每日APBR的肿瘤控制率极佳。本研究中可接受的毒性特征和美容效果支持在老年早期BC患者中使用IMRT计划的每日APBR方案。
