Yadav Budhi Singh, Bansal Anshuma, Kuttikat Philip George, Das Deepak, Gupta Ankita, Dahiya Divya
Department of Radiation Oncology, Regional Cancer Centre, Postgraduate Institute of Medical Education & Research, Chandigarh, India.
Department of Radiation Oncology, Rajindra Hospital, Patiala, Punjab, India.
Radiat Oncol J. 2020 Jun;38(2):109-118. doi: 10.3857/roj.2020.00129. Epub 2020 Jun 4.
Hypofractionated radiotherapy (RT) is becoming a new standard in postoperative treatment of patients with early stage breast cancer after breast conservation surgery. However, data on hypofractionation in patients with advanced stage disease who undergo mastectomy followed by local and regional nodal irradiation (RNI) is lacking. In this retrospective study, we report late-term effects of 3 weeks post-mastectomy hypofractionated local and RNI with two-dimensional (2D) technique in patients with stage II and III breast cancer.
Between January 1990 and December 2007, 1,770 women with breast cancer who were given radical treatment with mastectomy, systemic therapy and RT at least 10 years ago were included. RT dose was 35 Gy/15 fractions/3 weeks to chest wall by two tangential fields and 40 Gy in same fractions to supraclavicular fossa (SCF) and internal mammary nodes (IMNs). SCF and IMNs dose was prescribed at dmax and 3 cm depth, respectively. Chemotherapy and hormonal therapy was given in 64% and 74% patients, respectively. Late-term toxicities were assessed with the Radiation Therapy Oncology Group (RTOG) scores and LENT-SOMA scales (the Late Effects Normal Tissue Task Force-Subjective, Objective, Management, Analytic scales).
Mean age was 48 years (range, 19 to 75 years). Median follow-up was 12 years (range, 10 to 27 years). Moderate/marked arm/shoulder pain was reported by 254 (14.3%) patients. Moderate/marked shoulder stiffness was reported by 219 (12.3%) patients. Moderate/marked arm edema was seen in 131 (7.4%) patients. Brachial plexopathy was not seen in any patient. Rib fractures were noted in 6 (0.3%) patients. Late cardiac and lung toxicity was seen in 29 (1.6%) and 23 (1.3%) patients, respectively. Second malignancy developed in 105 (5.9%) patients.
RNI with 40 Gy/15 fractions/3 weeks hypofractionation with 2D technique seems safe and comparable to historical data of conventional fractionation (ClinicalTrial.gov Registration No. XXXX).
在保乳手术后，大分割放疗（RT）正成为早期乳腺癌患者术后治疗的新标准。然而，对于接受乳房切除术后进行局部及区域淋巴结照射（RNI）的晚期疾病患者，大分割放疗的数据尚缺乏。在这项回顾性研究中，我们报告了采用二维（2D）技术对II期和III期乳腺癌患者进行乳房切除术后3周大分割局部及RNI的晚期效应。
纳入1990年1月至2007年12月期间1770例至少在10年前接受了乳房切除、全身治疗和放疗的乳腺癌女性患者。通过两个切线野对胸壁给予放疗剂量35 Gy/15次/3周，对锁骨上窝（SCF）和内乳淋巴结（IMNs）给予相同分割剂量40 Gy。SCF和IMNs的剂量分别在最大剂量点（dmax）和3 cm深度处规定。分别有64%和74%的患者接受了化疗和激素治疗。采用放射治疗肿瘤学组（RTOG）评分和LENT-SOMA量表（晚期效应正常组织特别工作组-主观、客观、管理、分析量表）评估晚期毒性。
平均年龄为48岁（范围19至75岁）。中位随访时间为12年（范围10至27年）。254例（14.3%）患者报告有中度/重度手臂/肩部疼痛。219例（12.3%）患者报告有中度/重度肩部僵硬。131例（7.4%）患者出现中度/重度手臂水肿。未发现任何患者有臂丛神经病变。6例（0.3%）患者出现肋骨骨折。分别有29例（1.6%）和23例（1.3%）患者出现晚期心脏和肺部毒性。105例（5.9%）患者发生第二原发恶性肿瘤。
采用2D技术进行40 Gy/15次/3周大分割的RNI似乎是安全的，且与传统分割的历史数据相当（ClinicalTrial.gov注册号XXXX）。
