Department of Radiation Oncology, Government General Hospital, Guntur, Andhra Pradesh,, India.
Department of Radiation Oncology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana,, India.
J Cancer Res Ther. 2020 Oct-Dec;16(6):1309-1313. doi: 10.4103/jcrt.JCRT_241_20.
Bilateral breast irradiation is technically challenging and there is limited information regarding optimal technique and outcomes. Hypofractionated Radiotherapy (HFRT) has emerged as the new standard of care in early breast cancer. However, there are concerns in using hypofractionation for bilateral breast irradiation due to larger volumes and potential toxicity. Our aim was to analyze the dosimetric data and clinical outcomes in these patients.
Patients with synchronous bilateral breast cancer (SBBC) treated with bilateral breast irradiation were analyzed. All patients received simultaneous bilateral breast with or without regional nodal irradiation using a hypofractionated schedule of 40 Gy in 15 fractions over 3 weeks with single isocenter bi-tangential field-in-field intensity-modulated radiation therapy (FIF-IMRT) technique.
Seven patients of SBBC were treated at our institute from 2015 to 2017. All patients were postmenopausal females. Five patients underwent bilateral modified radical mastectomy; two patients underwent bilateral breast conservative surgery. All patients received systemic anthracycline-based chemotherapy. The mean cardiac dose was 3.73 ± Gy and V 25 was 3.26% ± 1.96%. V 20 of lung ranged from 23.48% ± 4.47% and the mean esophageal dose was 3.6 ± 2.00 Gy. No patient had acute toxicity higher than Grade 2. At a median follow-up of 48 months, one patient died due to systemic progression. No patient reported any late toxicity.
Bilateral breast irradiation using a hypofractionated schedule with single isocenter FIF-IMRT technique is technically feasible with minimal acute toxicity and no significant late effects on early follow-up.
双侧乳房照射在技术上具有挑战性，关于最佳技术和结果的信息有限。在早期乳腺癌中，缩短放疗（HFRT）已成为新的标准治疗方法。然而，由于较大的体积和潜在毒性，在双侧乳房照射中使用缩短放疗存在一些担忧。我们的目的是分析这些患者的剂量学数据和临床结果。
分析了接受双侧乳房照射的同步双侧乳腺癌（SBBC）患者。所有患者均采用 40Gy/15 次/3 周的短程分割方案，采用单中心双侧切线野内野调强放疗（FIF-IMRT）技术，同时或不进行区域淋巴结照射。
2015 年至 2017 年，我院共治疗 7 例 SBBC 患者。所有患者均为绝经后女性。5 例患者行双侧改良根治性乳房切除术；2 例患者行双侧保乳手术。所有患者均接受了基于蒽环类药物的全身化疗。平均心脏剂量为 3.73±Gy，V25 为 3.26%±1.96%。肺 V20 范围为 23.48%±4.47%，平均食管剂量为 3.6±2.00Gy。无患者出现高于 2 级的急性毒性。中位随访 48 个月时，1 例患者因全身进展而死亡。无患者报告任何晚期毒性。
采用单中心 FIF-IMRT 技术的短程分割方案进行双侧乳房照射在技术上是可行的，急性毒性低，在早期随访中无明显晚期效应。
