Division of Radiation Oncology, Department of Radiology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
Faculty of Allied Health Sciences, Chulalongkorn University, Bangkok, Thailand.
Breast J. 2020 Oct;26(10):1946-1952. doi: 10.1111/tbj.13960. Epub 2020 Jul 9.
To compare patient-rated cosmetic and satisfactory outcomes between conventional fractionation with simultaneously integrated boost (C-SIB) vs hypofractionation with SIB (H-SIB) in early breast cancer. Patients with stage I and II breast cancer who received breast-conserving surgery followed by radiation with SIB to tumor bed and completed questionnaire were included in this study. Radiotherapy was as follows: C-SIB arm = 50 Gy and 65 Gy in 25 fractions and H-SIB arm = 43.2 Gy and 52.8 Gy in 16 fractions to the whole breast and tumor bed, respectively. Single cross-sectional assessment of the breast cosmesis was done by patients and radiation oncologist at a follow-up visit. Breast cosmetic and satisfaction scores were collected using a four-point Harvard/NSABP/RTOG cosmesis criteria scale and a four-point Likert-type scale, respectively. Of a total of 114 patients (C-SIB = 57) and (H-SIB = 57) arms, a median time from radiotherapy completion to questionnaire response was 7.2 years. Patient-rated cosmetic outcome in C-SIB vs H-SIB was "excellent" in 40.3% vs 45.6%, "good" in 33.3% vs 42.1%, "fair" in 21.1% vs 10.5%, and "poor" in 5.3% vs 1.8% (P = .288). Corresponding satisfaction was "very satisfied" in 52.6% vs 57.9%, "satisfied" in 40.4% vs 35.1%, "neutral" in 7.0% vs 5.2%, and "unsatisfied" in 0% vs 1.8% (P = .683). Stage I and older age at radiotherapy were predictors for favorable (good or excellent) cosmesis and satisfaction, respectively. In early-stage breast cancer, H-SIB provided a trend for better cosmesis than C-SIB while maintaining satisfaction. The reduction in treatment duration and cost as well as favorable cosmesis outcomes encourages the use of H-SIB.
比较早期乳腺癌常规分割同步整合推量（C-SIB）与超分割同步整合推量（H-SIB）的患者自评美容和满意度结果。本研究纳入了接受保乳手术后接受 SIB 放疗并完成问卷调查的 I 期和 II 期乳腺癌患者。放疗如下：C-SIB 组=50Gy 和 65Gy，25 次分割；H-SIB 组=43.2Gy 和 52.8Gy，全乳和肿瘤床各 16 次分割。在随访时，由患者和放疗科医生对乳房美容进行单次横断面评估。使用四点哈佛/NSABP/RTOG 美容标准量表和四点李克特量表分别收集乳房美容和满意度评分。在总共 114 例患者（C-SIB 组=57 例）和（H-SIB 组=57 例）中，从放疗完成到问卷回复的中位时间为 7.2 年。C-SIB 组与 H-SIB 组的患者自评美容结果分别为“优秀”占 40.3%和 45.6%，“良好”占 33.3%和 42.1%，“中等”占 21.1%和 10.5%，“差”占 5.3%和 1.8%（P=.288）。相应的满意度分别为“非常满意”占 52.6%和 57.9%，“满意”占 40.4%和 35.1%，“中立”占 7.0%和 5.2%，“不满意”占 0%和 1.8%（P=.683）。I 期和放疗时年龄较大是美容和满意度的良好预测因素。在早期乳腺癌中，H-SIB 在保持满意度的同时，提供了比 C-SIB 更好的美容效果趋势。治疗时间和成本的减少以及良好的美容效果鼓励使用 H-SIB。
