Loganadane G, Xi Z, Fournier-Bidoz N, Xu H P, Grellier Adedjouma N, Bazire L, Fourquet A, Kirova Y M
Département d'oncologie-radiothérapie, institut Curie, 25, rue d'Ulm, 75005 Paris, France; Département d'oncologie-radiothérapie, centre sein, CHU Henri-Mondor, univeristé Paris-Est Créteil, INSERM unit 955, EQ 07, IMRB, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94010 Créteil,France.
Département d'oncologie-radiothérapie, institut Curie, 25, rue d'Ulm, 75005 Paris, France.
Cancer Radiother. 2019 Feb;23(1):38-45. doi: 10.1016/j.canrad.2018.04.005. Epub 2018 Dec 27.
The purpose of this study was to evaluate locoregional control and describe the patterns of locoregional failure in women with breast cancer irradiated by a previously described post-mastectomy highly conformal electron beam radiotherapy technique.
We included all women irradiated by post-mastectomy highly conformal electron beam radiotherapy technique for non-metastatic breast cancer between 2007 and 2011 in our department. All cases of bilateral breast cancer were excluded. All patients who experienced locoregional recurrence have been studied. Mapping patterns of regional recurrences was also performed and compared with the European Society for Radiotherapy and Oncology (ESTRO) and Radiotherapy Oncology Group (RTOG) guidelines of volume definition and delineation guidelines.
With a median follow-up of 64 months (range: 6-102 months), 5-year locoregional recurrence-free and overall survival probabilities were 90 % (95 % confidence interval [95 %CI]: 88.1-92.4) and 90.9 % (95 %CI: 88.9-93), respectively. Among the 796 patients included in the study, 23 patients (2.9 %) presented locoregional recurrences of them only 13 (1.6%) were presented with local recurrence. The majority of them presented aggressive biological features with grade III tumours in 17 patients (74 %) with high mitotic index in 16 cases (70 %) and triple negative tumours in 12 (52 %). Lymphovascular invasion was observed in 11 cases (48 %). In 14 cases the locoregional recurrences were diagnosed at the same time as the metastatic disease whereas 4 patients presented distant metastases secondarily. Locoregional recurrences occurred in 11 cases "in field" although adequate doses and volumes were used and in 12 cases "outfield", out of irradiated volume. Local recurrences occurred in 13 patients with 12 recurrences within the irradiated volumes. Regional recurrences occurred in 13 patients with 15 lymph nodes metastases identified. Four nodal recurrences occurred outside the ESTRO clinical target volume and within the RTOG clinical target volume and two occurred outside both RTOG and ESTRO clinical target volumes.
In presented series, the local recurrence resulted mostly from of biologic radio resistance whereas regional recurrences were caused by geographical miss. A number of nodal recurrences could occur outside the target volumes defined by ESTRO and RTOG.
本研究旨在评估局部区域控制情况，并描述采用先前所述的乳房切除术后高剂量适形电子束放射治疗技术照射的乳腺癌女性患者的局部区域失败模式。
我们纳入了2007年至2011年间在我院接受乳房切除术后高剂量适形电子束放射治疗技术治疗的所有非转移性乳腺癌女性患者。所有双侧乳腺癌病例均被排除。对所有发生局部区域复发的患者进行了研究。还对区域复发的图谱模式进行了分析，并与欧洲放射治疗与肿瘤学会（ESTRO）和放射治疗肿瘤学组（RTOG）的体积定义和勾画指南进行了比较。
中位随访时间为64个月（范围：6 - 102个月），5年局部区域无复发生存率和总生存率分别为90%（95%置信区间[95%CI]：88.1 - 92.4）和90.9%（95%CI：88.9 - 93）。在纳入研究的796例患者中，23例（2.9%）出现局部区域复发，其中仅13例（1.6%）为局部复发。大多数患者具有侵袭性生物学特征，17例（74%）为III级肿瘤，16例（70%）有高有丝分裂指数，12例（52%）为三阴性肿瘤。11例（48%）观察到淋巴管浸润。14例患者的局部区域复发与转移疾病同时诊断，4例患者继发远处转移。尽管使用了足够的剂量和体积，但仍有11例局部区域复发发生在“射野内”，12例发生在“射野外”，即照射体积之外。13例患者发生局部复发，其中12例复发在照射体积内。13例患者发生区域复发，共发现15处淋巴结转移。4处淋巴结复发发生在ESTRO临床靶体积之外但在RTOG临床靶体积内，2处发生在RTOG和ESTRO临床靶体积之外。
在本系列研究中，局部复发主要源于生物性放射抵抗，而区域复发是由靶区遗漏所致。一些淋巴结复发可能发生在ESTRO和RTOG定义的靶体积之外。
