每日分割外照射加速部分乳房照射至 40Gy 耐受良好且局部有效。
Daily Fractionation of External Beam Accelerated Partial Breast Irradiation to 40 Gy Is Well Tolerated and Locally Effective.
机构信息
Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York.
Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, New York.
出版信息
Int J Radiat Oncol Biol Phys. 2019 Jul 15;104(4):859-866. doi: 10.1016/j.ijrobp.2019.02.050. Epub 2019 Mar 7.
PURPOSE
Most studies examining accelerated partial breast irradiation (APBI) have used twice-daily fractionation. Cosmesis with this approach has produced mixed results, and the optimal fractionation scheme remains unknown. We sought to evaluate the safety and efficacy of APBI with a total dose of 40 Gy in 10 daily fractions.
METHODS AND MATERIALS
Between 2010 and 2014, we prospectively enrolled 106 patients to receive APBI after lumpectomy for invasive or in situ node-negative breast cancer. Radiation was administered via 3-dimensional conformal techniques.
RESULTS
The median age was 62 years (range, 39-85), and all patients underwent APBI per protocol. With a median follow-up of 58 months, we evaluated patient-reported local toxicity and recurrence outcomes. Of 106 patients, 16 (15%) experienced grade ≥2 skin toxicity. The most common significant toxicities were acute cutaneous changes at 4 to 9 weeks after radiation therapy, including grade 2 erythema in 2 patients (1.8%) and skin color changes in 4 patients (3.8%). Only 2 instances of grade 3 toxicity were reported, including 1 patient with acute moist desquamation after radiation therapy and another with fibrosis at 2 years. Planning target volume and breast V were significantly predictive of skin/subcutaneous toxicity, with evidence that limiting breast V to <45% may improve tolerability. Overall, 3 breast cancer recurrences arose: 1 local recurrence in the original quadrant (3 years after APBI), 1 in a different ipsilateral quadrant (5 years after APBI), and 1 with distant disease 2 years after APBI.
CONCLUSIONS
In an appropriately selected group of patients with early stage breast cancer, APBI to a dose of 40 Gy in 10 daily fractions was well tolerated, with most patients (99%) reporting excellent/good cosmesis. Planning target volume and breast V should be carefully constrained to limit local morbidity. Longer follow-up will be needed to establish efficacy and subsequent local recurrence rates.
目的
大多数研究检查加速部分乳房照射（APBI）使用了每日两次分割。这种方法的美容效果产生了混合的结果，最佳分割方案仍不清楚。我们试图评估 40Gy 总剂量分 10 次每日分割的 APBI 的安全性和有效性。
方法和材料
在 2010 年至 2014 年期间，我们前瞻性地招募了 106 例接受保乳手术后浸润性或原位淋巴结阴性乳腺癌的患者接受 APBI。辐射通过三维适形技术进行。
结果
中位年龄为 62 岁（范围 39-85），所有患者均按方案接受 APBI。中位随访 58 个月后，我们评估了患者报告的局部毒性和复发结果。在 106 例患者中，有 16 例（15%）发生了≥2 级皮肤毒性。最常见的显著毒性是放射治疗后 4 至 9 周的急性皮肤变化，包括 2 例患者（1.8%）出现 2 级红斑和 4 例患者（3.8%）出现皮肤颜色改变。仅报告了 2 例 3 级毒性，包括 1 例患者在放射治疗后出现急性湿性脱皮，另 1 例患者在 2 年后出现纤维化。计划靶区和乳房 V 是皮肤/皮下毒性的显著预测因子，证据表明将乳房 V 限制在<45%可能会提高耐受性。总的来说，有 3 例乳腺癌复发：1 例在 APBI 后 3 年在原象限发生局部复发，1 例在 APBI 后 5 年在同侧象限发生，1 例在 APBI 后 2 年发生远处疾病。
结论
在适当选择的早期乳腺癌患者组中，40Gy 总剂量分 10 次每日分割的 APBI 耐受性良好，大多数患者（99%）报告美容效果极好/良好。应仔细限制计划靶区和乳房 V，以限制局部发病率。需要更长时间的随访才能确定疗效和随后的局部复发率。
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