Department of Radiation-Oncology, Institut Paoli-Calmettes, Marseille, France.
CRCM, Institut Paoli-Calmettes, Marseille, France.
Breast J. 2020 Nov;26(11):2145-2150. doi: 10.1111/tbj.13827. Epub 2020 Mar 31.
This French study reports the 5-year results of partial-breast irradiation using intraoperative radiation therapy (IORT) with 50 kV x-rays, in select early breast cancer patients. We report a retrospective analysis of 676 consecutive early breast cancer patients treated between November 2011 and December 2015 by partial-breast irradiation using the INTRABEAM system. Patients were highly selected based on the ASTRO and GEC-ESTRO criteria and underwent breast-conservative surgery and IORT, completed with additional whole-breast irradiation (WBI) when unexpected unfavorable prognostic factors were found at the final pathology report. Patients' outcomes relative to local and distant control, overall and breast cancer-specific survival, and toxicity are presented, as well as rates of additional WBI. Additional WBI was mandatory in one third of patients (31%), mainly due to lymph node involvement and extensive intraductal component. With a median follow-up time of 54 months, the 5-year local recurrence rate was 1.7% [95%CI: 0.9-3.3]; the median time to local recurrence was 23 months; ipsilateral breast recurrences mainly occurred in the same quadrant (7/11); in the restricted population, meeting all predefined criteria and treated with IORT alone (406 patients), the local recurrence rate was 1.5% [95%CI: 0.6-3.6]. Five-year distant tumor control was 98.6% [95%CI: 97.2-99.3], and the median time to distant recurrence was 22 months. Five-year overall survival was 96.5% [95%CI: 94.2-97.8], and 5-year breast cancer-specific survival was 98.9% [95%CI: 97.6-99.7]. In patients treated with IORT alone, there was no grade 3 toxicity, only four grade 3 (mainly fibrosis) affected patients treated with IORT and WBI. Grade 1-2 toxicity rates were 14% and 34.4% in patients treated with IORT alone and IORT plus WBI, respectively. Partial-breast irradiation using IORT by a 50 kV photon device is safe and well-tolerated in select patients with early breast cancer and is a valuable option in patients reluctant for adjuvant WBI.
这项法国研究报告了使用术中放射治疗（IORT）进行 50kV X 射线部分乳房照射治疗选择的早期乳腺癌患者的 5 年结果。我们报告了 2011 年 11 月至 2015 年 12 月期间通过 INTRABEAM 系统接受部分乳房照射治疗的 676 例连续早期乳腺癌患者的回顾性分析。根据 ASTRO 和 GEC-ESTRO 标准，患者经过高度选择，并接受保乳手术和 IORT，如果最终病理报告发现意外的不利预后因素，则完成额外的全乳房照射（WBI）。报告了患者在局部和远处控制、总生存和乳腺癌特异性生存方面的结果，以及接受额外 WBI 的比率。由于淋巴结受累和广泛的管内成分，三分之一的患者（31%）需要强制性接受额外的 WBI。在中位随访时间为 54 个月时，5 年局部复发率为 1.7%[95%CI：0.9-3.3]；局部复发的中位时间为 23 个月；同侧乳房复发主要发生在同一象限（7/11）；在限制人群中，符合所有预设标准并单独接受 IORT 治疗（406 例）的患者，局部复发率为 1.5%[95%CI：0.6-3.6]。5 年远处肿瘤控制率为 98.6%[95%CI：97.2-99.3]，远处复发的中位时间为 22 个月。5 年总生存率为 96.5%[95%CI：94.2-97.8]，5 年乳腺癌特异性生存率为 98.9%[95%CI：97.6-99.7]。在单独接受 IORT 治疗的患者中，无 3 级毒性，仅 4 例 3 级（主要为纤维化）受影响患者接受 IORT 和 WBI 治疗。单独接受 IORT 和 IORT 加 WBI 治疗的患者中，1-2 级毒性发生率分别为 14%和 34.4%。在选择的早期乳腺癌患者中，使用 50kV 光子设备进行 IORT 的部分乳房照射是安全且耐受良好的，并且对于不愿意接受辅助 WBI 的患者是一种有价值的选择。
