Bhandari Tanuja, Babaran Wesley, Forouzannia Afshin, Williams Venita, Harness Jay, Carpenter Michele, Gobran Maher, Khanijou Rajesh, Wagman Brittany, Ash Robert, Wagman Lawrence D
The Center for Cancer Prevention and Treatment at St. Joseph Hospital, Orange, CA.
The Center for Cancer Prevention and Treatment at St. Joseph Hospital, Orange, CA.
Brachytherapy. 2017 Nov-Dec;16(6):1232-1238.e2. doi: 10.1016/j.brachy.2017.09.002. Epub 2017 Oct 9.
Radiation therapy is proven to reduce local recurrence in patients with early-stage breast cancer. To reduce toxicity, treatment time, and improve accuracy, intraoperative radiation therapy was used as definitive treatment or as a boost. The study's objective was to compare the short-term toxicity and cosmesis of single-fraction (SF) IORT and hypofractionated radiotherapy with IORT boost (HfB) given as definitive treatment.
Between March 2011 and December 2013, 57 patients aged 45-91 years and 24 patients aged 43-83 years (total n = 81) with Stage 0-II were treated with SF or HfB (Mobetron, IntraOp Medical, Sunnyvale, CA). For SF treatment, 21 Gy was delivered using 4.5-6 cm applicators with electron energies from 6 to 12 MeV. For HfB, an intraoperative boost of 10 Gy was delivered using 4-7 cm applicators with energies from 4 to 12 MeV followed by whole-breast radiation with 40.5 Gy over 15 fractions. Toxicity was assessed at 2 weeks, 6 months, and 12 months per Radiation Therapy Oncology Group acute skin toxicity criteria and cosmesis.
At 12 months, SF and HfB were well tolerated by all patients with no Grade 3+ toxicity. At 1 year, Grade-2 toxicity was resolved. Ninety-eight percent of SF patients and ninety percent of HfB patients had 0-1 grade toxicity. In the SF and HfB groups, 100% of patients had excellent or good cosmesis at 12-month followup interval. The SF exhibited a more favorable cosmesis with a higher percentage of excellent scores compared with HfB (80.4% vs. 45%; p = 0.0033).
After breast conservation surgery, SF or HfB may be an option for patients with early-stage breast cancer compared to conventional external beam radiotherapy.
放射治疗已被证明可降低早期乳腺癌患者的局部复发率。为了降低毒性、缩短治疗时间并提高准确性，术中放射治疗被用作根治性治疗或辅助治疗。本研究的目的是比较单次分割（SF）术中放射治疗与术中放射治疗辅助的大分割放射治疗（HfB）作为根治性治疗的短期毒性和美容效果。
2011年3月至2013年12月期间，57例年龄在45 - 91岁的患者和24例年龄在43 - 83岁的患者（共81例）0 - II期患者接受了SF或HfB治疗（Mobetron，IntraOp Medical，桑尼维尔，加利福尼亚州）。对于SF治疗，使用4.5 - 6厘米的施源器，电子能量为6至12兆电子伏，给予21戈瑞的剂量。对于HfB，使用4 - 7厘米的施源器，能量为4至12兆电子伏，术中给予10戈瑞的辅助剂量，随后进行全乳放射治疗，15次分割给予40.5戈瑞。根据放射治疗肿瘤学组的急性皮肤毒性标准和美容效果，在2周、6个月和12个月时评估毒性。
在12个月时，所有患者对SF和HfB的耐受性良好，无3级以上毒性。在1年时，2级毒性消失。98%的SF患者和90%的HfB患者有0 - 1级毒性。在SF和HfB组中，100%的患者在12个月的随访期内美容效果为优或良。与HfB相比，SF的美容效果更优，优秀评分的百分比更高（80.4%对45%；p = 0.0033）。
与传统外照射放疗相比，保乳手术后，SF或HfB可能是早期乳腺癌患者的一种选择。
