Hepel Jaroslaw T, Yashar Catheryn, Leonard Kara L, Einck John P, Sha Sandra, DiPetrillo Thomas, Wiggins Doreen, Graves Theresa A, Edmonson David, Wazer David E
Department of Radiation Oncology, Rhode Island Hospital, Brown University, Providence, RI; Department of Radiation Oncology, Tufts Medical Center, Tufts University, Boston, MA.
Department of Radiation Oncology, University of California, San Diego, La Jolla, CA.
Brachytherapy. 2018 Sep-Oct;17(5):825-830. doi: 10.1016/j.brachy.2018.05.006. Epub 2018 Jun 21.
To improve efficiency, convenience, and cost, a prospective phase II trial was initiated to evaluate accelerated partial breast irradiation delivered with noninvasive image-guided breast brachytherapy (NIBB) via five once-daily fractions.
Women ≥50 years old with early-stage breast cancer undergoing breast conserving surgery were enrolled. Eligibility criteria included invasive carcinoma ≤2.0 cm or ductal carcinoma in situ ≤3.0 cm, ER positive (if invasive), lymph node negative, LVI absent, and margins negative by 2 mm. Patients received a total dose of 28.5 Gy in five daily fractions. NIBB was delivered using two orthogonal axes for each fraction. Applicators were selected to encompass the lumpectomy cavity with a 1.0 cm clinical target volume margin and 0 to 0.5 cm planning target volume margin. Acute and late toxicity was assessed based on CTCAE v3.0.
Forty patients with a mean age of 67 years underwent protocol treatment. Mean tumor size was 1.0 cm (0.3-2.0 cm). Eighty percent had invasive carcinoma and the remainder had ductal carcinoma in situ. Mean tumor bed volume was 21 cc (5-79 cc) and mean breast volume was 1319 cc (499-3044 cc). Mean breast separation with compression was 6.7 cm (3.5-8.9 cm). All patients tolerated well. Median discomfort with compression was 1 (range: 0-7) on a 10-point pain scale. Acute skin reaction was Grade 0-1 in 70%, Grade 2 in 28%, and Grade 3 in 3%. Acute skin toxicity was not associated with breast size but was associated with larger breast separation with compression (p < 0.01) and larger applicator size (p < 0.01). No Grade 3+ late toxicity or local recurrences have been observed at a median followup of 14 months.
Accelerated partial breast irradiation delivered using NIBB over five daily fractions is a convenient treatment option that is feasible and well tolerated.
为提高效率、便利性和成本效益，开展了一项前瞻性II期试验，以评估通过无创图像引导乳腺近距离放射治疗（NIBB）分五个每日一次的分割剂量进行的加速部分乳腺照射。
纳入年龄≥50岁、接受保乳手术的早期乳腺癌女性患者。入选标准包括浸润性癌≤2.0 cm或原位导管癌≤3.0 cm、雌激素受体阳性（如为浸润性癌）、淋巴结阴性、无淋巴血管浸润，且切缘阴性2 mm。患者接受总剂量28.5 Gy，分五个每日分割剂量。每次分割剂量使用两个正交轴进行NIBB照射。选择施源器，使其在临床靶区边缘外扩1.0 cm、计划靶区边缘外扩0至0.5 cm的情况下覆盖肿块切除腔。根据CTCAE v3.0评估急性和晚期毒性。
40例平均年龄67岁的患者接受了方案治疗。平均肿瘤大小为1.0 cm（0.3 - 2.0 cm）。80%为浸润性癌，其余为原位导管癌。平均瘤床体积为21 cc（5 - 79 cc），平均乳房体积为1319 cc（499 - 3044 cc）。压缩状态下的平均乳房间距为6.7 cm（3.5 - 8.9 cm）。所有患者耐受性良好。在10分疼痛量表上，压缩引起的不适中位数为1（范围：0 - 7）。70%的患者急性皮肤反应为0 - 1级，28%为2级，3%为3级。急性皮肤毒性与乳房大小无关，但与压缩状态下较大的乳房间距（p < 0.01）和较大的施源器尺寸（p < 0.01）有关。在中位随访14个月时，未观察到3级及以上晚期毒性或局部复发。
使用NIBB分五个每日分割剂量进行加速部分乳腺照射是一种方便的治疗选择，可行且耐受性良好。
