Bronsart Estelle, Dureau Sylvain, Xu Hao Ping, Bazire Louis, Chilles Anne, Costa Emilie, Logerot Christelle, Falcou Marie-Christine, Campana Francois, Berger Frédérique, Fourquet Alain, Kirova Youlia M
Institut Curie, Department of Radiation Oncology, Paris, France.
Institut Curie, Unit of Biometry, Paris, France.
Radiother Oncol. 2017 Aug;124(2):214-219. doi: 10.1016/j.radonc.2017.07.001. Epub 2017 Jul 19.
To evaluate previously published whole breast radiotherapy (WBRT) using ILD (isocentring lateral decubitus) technique in terms of toxicity and efficacy.
From 2006 to 2010, 832 female patients with early-stage breast cancer (BC) treated by conservative surgery underwent 3D-conformal WBRT-ILD at Institut Curie. The acute toxicity of treatment was evaluated weekly and the late toxicity (6months and later after the treatment) was evaluated every 6months till the 5th year after the end of the radiotherapy using NCI CTC v3.0 scale. Dosimetric study was performed to analyse the mean cardiac dose and the mean homolateral and contralateral lung doses.
The median follow up was 6.4years. The median age was 61.5years (range, 29-90), and median body mass index (BMI) was 26.3. Fifty one percent of the patients presented left sided BC and 49% right sided. Different type of fractions were used: 46.5% of pts.: 50 (breast)+16Gy (boost) in 33fractions (fr), in 17.9%-50Gy/25fr, in 26.1%-40/15fr or 41.6Gy/13fr and in 9.5%: 30Gy/5fr. Acute dermatitis was present in 93% with a median of apparition of 4weeks, and only 2,8% grade 3. In multivariate analysis, the cup size had significant influence (p=0.0004) and the fractionation had a significative influence (p=0.0001). In the all patients' population, 94.1% of cases had no skin toxicity at 1year. No cardiac or pulmonary toxicity was reported. The median overall survival had not been reached at the end of follow-up. We observed 36 (3.6%) recurrences, as following: 30 local (breast) recurrences, 4 lymph node (LN), and 2pts experiencing both.
Whole breast radiotherapy in the lateral decubitus position provides excellent results in terms of local control and survival. ILD is well tolerated with very good acute toxicity profile. No cardiac or pulmonary toxicity were observed in this study. Longer follow-up is needed to confirm these results.
从毒性和疗效方面评估先前发表的采用仰卧位外照射（ILD）技术的全乳放疗（WBRT）。
2006年至2010年，832例接受保乳手术的早期乳腺癌（BC）女性患者在居里研究所接受了三维适形WBRT-ILD治疗。每周评估治疗的急性毒性，使用美国国立癌症研究所（NCI）常见毒性标准（CTC）v3.0量表，每6个月评估一次晚期毒性（治疗后6个月及以后），直至放疗结束后第5年。进行剂量学研究以分析平均心脏剂量以及同侧和对侧肺的平均剂量。
中位随访时间为6.4年。中位年龄为61.5岁（范围29 - 90岁），中位体重指数（BMI）为26.3。51%的患者为左侧乳腺癌，49%为右侧。采用了不同类型的分割方式：46.5%的患者：50（乳房）+16Gy（加量），分33次分割（fr）；17.9%为50Gy/25fr；26.1%为40/15fr或41.6Gy/13fr；9.5%为30Gy/5fr。93%的患者出现急性皮炎，中位出现时间为4周，仅2.8%为3级。多因素分析中，罩杯大小有显著影响（p = 0.0004），分割方式有显著影响（p = 0.0001）。在所有患者群体中，94.1%的病例在1年时无皮肤毒性。未报告心脏或肺部毒性。随访结束时中位总生存期尚未达到。我们观察到36例（3.6%）复发，如下：30例局部（乳房）复发，4例淋巴结（LN）复发，2例患者同时出现这两种情况。
仰卧位全乳放疗在局部控制和生存方面取得了优异结果。ILD耐受性良好，急性毒性表现极佳。本研究中未观察到心脏或肺部毒性。需要更长时间的随访来证实这些结果。
