Ovalle Valentina, Strom Eric A, Shaitelman Simona, Hoffman Karen, Amos Richard, Perkins George, Tereffe Welela, Smith Benjamin D, Stauder Michael, Woodward Wendy
Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA.
Cancers (Basel). 2018 Apr 7;10(4):111. doi: 10.3390/cancers10040111.
Accelerated partial breast irradiation (APBI) with protons results in a very different acute effect profile than standard whole breast irradiation. We reviewed our initial experience with proton APBI and felt that a detailed description of these effects were needed to permit a common tool to compare experience with this developing technology. Sixty sequential patients treated with proton APBI on a prospective protocol were evaluated and 43 patients with a minimum six-month follow-up underwent detailed photographic and radiologic analysis. The tumorectomy cavity plus an additional 1.5 cm clinical target volume (CTV) was treated with two or three passively-scattered proton beams to a dose of 34 Gy in 10 fractions in one week. Photographs were taken at the end of radiation, at two weeks, six weeks, and every six months thereafter. Mammography was obtained at six months after radiation and annually thereafter. All visual changes were categorized using the smallest meaningful gradations in findings and are demonstrated herein. All treatment-related mammographic findings are reported. Visual and mammographic findings showed a clear time-dependent relationship and significant variation between individuals. Peak skin reaction occurred at two to six weeks after completion of therapy. At two weeks most patients had either no visible effects and patchy erythema involving <50% of the treated skin (60%). At six weeks most patients had either patchy erythema involving <50% of the overlying skin (33%) or patchy erythema involving >50% of the treated skin (28%). Only one patient developed any moist desquamation. At six months most patients had no visible skin changes (57%) or a small, circular area of mild hyperpigmentation (33%). Mammographic changes seen at six months were regional skin thickening (40%), residual seroma (14%), localized retraction (26%), and fat necrosis (2%). A subcategorized variant on the CTCAE 4.0 was developed to foster granular recording of these findings.
质子束加速部分乳腺照射（APBI）所产生的急性效应与标准全乳照射截然不同。我们回顾了质子APBI的初步经验，认为需要对这些效应进行详细描述，以便提供一个通用工具来比较这项新兴技术的应用经验。对按照前瞻性方案接受质子APBI治疗的60例连续患者进行了评估，其中43例随访至少6个月的患者接受了详细的摄影和放射学分析。肿瘤切除腔加额外1.5厘米的临床靶区（CTV）用两束或三束被动散射质子束治疗，一周内分10次给予34 Gy剂量。在放疗结束时、两周、六周以及此后每六个月拍摄照片。放疗后6个月进行乳腺钼靶检查，此后每年进行一次。所有视觉变化均根据发现的最小有意义分级进行分类，并在此展示。报告了所有与治疗相关的乳腺钼靶检查结果。视觉和乳腺钼靶检查结果显示出明显的时间依赖性关系，且个体间存在显著差异。皮肤反应高峰出现在治疗完成后的两至六周。两周时，大多数患者无明显影响，或仅有斑片状红斑，累及治疗皮肤的比例<50%（60%）。六周时，大多数患者有斑片状红斑，累及覆盖皮肤的比例<50%（33%），或斑片状红斑累及治疗皮肤的比例>50%（28%）。只有1例患者出现了湿性脱屑。六个月时，大多数患者无明显皮肤变化（57%）或有小的圆形轻度色素沉着区域（33%）。放疗后6个月出现的乳腺钼靶变化包括局部皮肤增厚（40%）、残留血清肿（14%）、局限性回缩（26%）和脂肪坏死（2%）。开发了CTCAE 4.0的一个子分类变体，以促进对这些发现进行细致记录。
