Hannoun-Lévi Jean-Michel, Lam Cham Kee Daniel, Gal Jocelyn, Schiappa Renaud, Hannoun Arthur, Fouche Yves, Gautier Mathieu, Boulahssass Rabia, Chand Marie-Eve
Department of Radiation Oncology, Antoine Lacassagne Cancer Center, University of Cote d'Azur, Nice, France.
Department of Radiation Oncology, Antoine Lacassagne Cancer Center, University of Cote d'Azur, Nice, France.
Brachytherapy. 2020 Jan-Feb;19(1):90-96. doi: 10.1016/j.brachy.2019.10.007. Epub 2019 Nov 23.
To evaluate the clinical outcomes of a very-accelerated partial breast irradiation (vAPBI) in the elderly based on a single fraction of multicatheter interstitial high-dose rate brachytherapy (MIB). Mature results with a median follow-up of 5 years.
From November 2012 to September 2014, 26 patients (pts) (≥70) with early breast cancer were enrolled in a prospective phase II trial (NCT01727011). After lumpectomy, intraoperative catheter implant was performed for postoperative APBI (single fraction 16 Gy). Surveillance was performed twice a year after APBI. Oncologic outcome (local [LRFS], metastasis-free survival, cancer-specific survival, and overall survival [OS]) as well as late toxicity and cosmetic outcome were investigated.
Median age was 77 years [69-89]. After a median follow-up of 63 months [60-68], 5-year LRFS, metastasis-free survival, cancer-specific survival, and overall survival rates were 100%, 95.5%, 100%, and 88.5%, respectively. Late toxicity was observed in 5 pts (19.2%) with a total of five events: 3 pts G1 (60%); and 2 pts G2 (40%). The observed late side effects were breast pain in 1 pt (G2 cytosteatonecrosis with occasional acetaminophen consumption), hypopigmentation (puncture site) in 2 pts (G1) and breast fibrosis in 2 pts (G1: 1 pt; G2: 1 pt). Cosmetic evaluation was excellent for 21 pts (81%) and good for 2 pts (19%).
For elderly with early breast cancer, a vAPBI using a single fraction of postoperative MIB (16 Gy) provides excellent oncologic results, mainly in terms of local control and cancer death. Late toxicity and cosmetic profile are acceptable.
基于多导管组织间高剂量率近距离放射治疗（MIB）单次分割，评估老年患者超加速部分乳腺照射（vAPBI）的临床疗效。报告中位随访5年的成熟结果。
2012年11月至2014年9月，26例（≥70岁）早期乳腺癌患者入组一项前瞻性II期试验（NCT01727011）。保乳手术后，术中植入导管用于术后APBI（单次分割16 Gy）。APBI后每年进行两次监测。研究肿瘤学结局（局部复发无病生存[LRFS]、无转移生存、癌症特异性生存和总生存[OS]）以及晚期毒性和美容效果。
中位年龄为77岁[69 - 89岁]。中位随访63个月[60 - 68个月]后，5年LRFS、无转移生存、癌症特异性生存和总生存率分别为100%、95.5%、100%和88.5%。5例患者（19.2%）出现晚期毒性，共发生5起事件：3例1级（60%）；2例2级（40%）。观察到的晚期副作用包括：1例患者出现乳腺疼痛（2级细胞脂肪坏死，偶尔服用对乙酰氨基酚），2例患者出现色素减退（穿刺部位，1级），2例患者出现乳腺纤维化（1级1例；2级1例）。21例患者（81%）美容评估为优，2例患者（19%）为良。
对于老年早期乳腺癌患者，采用术后MIB单次分割（16 Gy）的vAPBI可提供优异的肿瘤学结果，主要体现在局部控制和癌症死亡方面。晚期毒性和美容效果可接受。
