Department of Human Structure and Repair, Ghent University, Belgium.
Department of Human Structure and Repair, Ghent University, Belgium; Department of Radiation Oncology, Ghent University Hospital, Belgium.
Breast. 2021 Feb;55:105-111. doi: 10.1016/j.breast.2020.12.009. Epub 2020 Dec 24.
Acceleration of radiotherapy in 5 fractions for breast cancer can reduce the burden of treatment. We report on acute toxicity after whole-breast irradiation with a simultaneous integrated boost in 5 fractions over 10-12 days.
Acute toxicity and health-related quality of life (HRQoL) of 200 patients, randomized between a 15- or 5-fractions schedule, were collected, using the CTCAE toxicity scoring system, the Multidimensional Fatigue Inventory, EORTC QLQ-C30 and BR23 and the BREAST-Q questionnaire. The prescribed dose to the breast was either 15∗2.67 Gy (40.05 Gy) or 5∗5.7 Gy (28.5 Gy). 90% of patients received a SIB to a cumulative dose of 46.8 Gy (15∗3.12 Gy) or 31 Gy (5∗6.2 Gy).
Physician-assessed toxicity was lower for the 5-fractions group. A significant difference was observed for breast pain (p = 0.002), fatigue (p < 0.0001), breast edema (p = 0.001) and dermatitis (p = 0.003). Patients treated in 5 fractions reported better mean HRQoL scores for breast symptoms (p = 0.001) and physical well-being (p = 0.001). A clinically important deterioration in HRQoL of 10 points or more was also less frequently observed in the latter group for physical functioning (p = 0.0005), social functioning (p = 0.0007), fatigue (p = 0.003), breast symptoms (p = 0.0002) and physical well-being (p = 0.002).
In this single institute study, acute toxicity of accelerated breast radiotherapy in 5 fractions over 10-12 days seems to compare favourably to hypofractionated breast radiotherapy in 15 fractions. Less breast edema, dermatitis, desquamation, breast pain and fatigue are seen. Social and physical functioning are also less disturbed and patients have a better future perspective.
加速乳腺癌放射治疗至 5 个疗程可减少治疗负担。我们报告了在 10-12 天内进行 5 个疗程的全乳房照射同时进行综合增量照射后的急性毒性。
200 例患者随机分为 15 或 5 个疗程组，使用 CTCAE 毒性评分系统、多维疲劳量表、EORTC QLQ-C30 和 BR23 以及 BREAST-Q 问卷收集急性毒性和健康相关生活质量（HRQoL）。乳房的规定剂量为 152.67 Gy（40.05 Gy）或 55.7 Gy（28.5 Gy）。90%的患者接受了 SIB 治疗，累积剂量为 46.8 Gy（153.12 Gy）或 31 Gy（56.2 Gy）。
医师评估的毒性在 5 个疗程组中较低。在乳房疼痛（p=0.002）、疲劳（p<0.0001）、乳房水肿（p=0.001）和皮炎（p=0.003）方面观察到显著差异。接受 5 个疗程治疗的患者报告乳房症状（p=0.001）和身体幸福感（p=0.001）的平均 HRQoL 评分更好。在后一组中，身体功能（p=0.0005）、社会功能（p=0.0007）、疲劳（p=0.003）、乳房症状（p=0.0002）和身体幸福感（p=0.002）方面，也较少观察到 HRQoL 恶化 10 分或以上的情况。
在这项单中心研究中，在 10-12 天内进行 5 个疗程的加速乳腺癌放射治疗的急性毒性似乎优于 15 个疗程的分次放射治疗。较少出现乳房水肿、皮炎、脱屑、乳房疼痛和疲劳。社会和身体功能也较少受到干扰，患者对未来的前景也更好。
