Mi Yin, Lv Pengwei, Wang Fang, Li Lin, Zhu Mingzhi, Wang Yanyan, Zhang Yingying, Liu Lele, Cao Qinchen, Dong Meilian, Shi Yonggang, Fan Ruitai, Li Jingruo, Gu Yuanting, Zuo Xiaoxiao
Department of Radiation Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
Department of Breast Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
Front Oncol. 2020 Oct 8;10:550327. doi: 10.3389/fonc.2020.550327. eCollection 2020.
To investigate the efficacy of targeted intraoperative radiotherapy (TARGIT) vs. conventional external beam radiotherapy (EBRT) in Chinese patients with breast cancer. We retrospectively analyzed breast cancer patients who underwent breast-conserving surgery (BCS) at our hospital between April 2009 and October 2017. Patients were divided into TARGIT group and EBRT group according to different radiotherapy methods. TARGIT was performed with low-energy X-rays emitted by the Intrabeam system to deliver a single dose of 20 Gy to the applicator surface. Propensity score matching was performed at 1:1. The Kaplan-Meier method was used to calculate the locoregional recurrence (LR), distant metastasis-free survival (DMFS), disease-free survival (DFS), and overall survival (OS) of the two groups, and the log-rank test was run to analyse between-group difference before and after matching. A total of 281 patients were included, with a median follow-up of 43 months. Of them, 82 were included in the TARGIT group and 199 in the EBRT group. Using the risk-adapted approach, 6.1% of patients received supplemental EBRT in the TARGIT group. The 5-year LR rate was 3.2% in the TARGIT group and 3.1% in the EBRT group ( = 0.694), the 5-year DMFS rates were 100 and 96.7%, respectively ( = 0.157); the 5-year DFS rates were 96.8 and 94.2% ( = 0.604); and the 5-year OS rates were 97.6 and 97.8% ( = 0.862). After matching which eliminated interference from imbalanced baseline factors, 128 matched patients were analyzed by the Kaplan-Meier method. The 5-year LR rate was 2.3% in the TARGIT group and 1.6% in the EBRT group; the 5-year DMFS rates were 100 and 98.4%, respectively; the 5-year DFS rates were 97.7 and 98.4%; and the 5-year OS rates were 98.4 and 98.4% ( = 0.659, 0.313, 0.659, 0.987). There was no significant difference in efficacy between TARGIT group and EBRT group. TARGIT and EBRT have similar 5-year outcomes in selected Chinese breast cancer patients undergoing BCS, and it can be used as an effective alternative to standard therapy, with substantial benefits to patients. The results need to be further confirmed by extending the follow-up time.
为研究术中靶向放疗（TARGIT）与传统外照射放疗（EBRT）对中国乳腺癌患者的疗效。我们回顾性分析了2009年4月至2017年10月在我院接受保乳手术（BCS）的乳腺癌患者。根据不同放疗方法将患者分为TARGIT组和EBRT组。TARGIT采用Intrabeam系统发射的低能X射线，在施源器表面单次给予20 Gy剂量。进行1:1倾向评分匹配。采用Kaplan-Meier法计算两组的局部区域复发（LR）、无远处转移生存期（DMFS）、无病生存期（DFS）和总生存期（OS），并采用对数秩检验分析匹配前后的组间差异。共纳入281例患者，中位随访时间为43个月。其中，TARGIT组82例，EBRT组199例。采用风险调整方法，TARGIT组6.1%的患者接受了补充EBRT。TARGIT组5年LR率为3.2%，EBRT组为3.1%（P = 0.694）；5年DMFS率分别为100%和96.7%（P = 0.157）；5年DFS率分别为96.8%和94.2%（P = 0.604）；5年OS率分别为97.6%和97.8%（P = 0.862）。匹配消除了基线因素不平衡的干扰后，采用Kaplan-Meier法对128例匹配患者进行分析。TARGIT组5年LR率为2.3%，EBRT组为1.6%；5年DMFS率分别为100%和98.4%；5年DFS率分别为97.7%和98.4%；5年OS率分别为98.4%和98.4%（P = 0.659、0.313、0.659、0.987）。TARGIT组和EBRT组疗效无显著差异。在接受BCS的特定中国乳腺癌患者中，TARGIT和EBRT的5年结局相似，可作为标准治疗的有效替代方案，对患者有诸多益处。结果需通过延长随访时间进一步证实。
