Department of Radiation Oncology, Hospital Clínic of Barcelona, Barcelona, Spain.
Department of Gynecology Oncology, Hospital Clínic of Barcelona, Barcelona, Spain.
Clin Transl Oncol. 2021 Aug;23(8):1593-1600. doi: 10.1007/s12094-021-02555-3. Epub 2021 Feb 3.
The administration of a dose boost to the tumor bed after breast-conserving surgery has proven to reduce local recurrence. Intra-operative electron radiotherapy (IOERT) offers an alternative method to deliver a boost with several advantages, such as direct visualization of the tumor bed, less inter- and intrafraction motion and a reduction in the number of medical appointments. The objective of our study is to assess chronic toxicity and long-term outcome for our patients after IOERT boost.
Forty-six patients treated at our institution between July 2013 and June 2020 with IOERT boost during Breast-Conserving Surgery and consecutive whole breast irradiation were prospectively analyzed. A 10-12 Gy boost was prescribed to 42 patients and 4 patients received a 20 Gy boost. An analysis for overall survival, local relapse and distant progression was performed. Acute and chronic toxicity was assessed by CTCAE 4.0.
The median age was 64.5 years (40-90). The median follow-up was 62 months (4-86). We had no local recurrences but 2 patients (4.3%) presented a distant recurrence. Mean pathological tumor size was 16 mm (6-52). 84.8% (39) of the patients had invasive ductal carcinoma. 52.2% (24) presented histological grade II. 52.2% (24) were Luminal A like, 21.7% (10) Luminal B like, 13% (6) HER2 positive, 13% (6) triple negative. No Grade 3-4 chronic toxicity was observed. Grade 1-2 fibrosis was evidenced in 13% (6) of the patients, 4.3% (2) patients presented fat necrosis, 6.5% (3) presented seroma, 4.3% (2) had localized pain, 2.2% (1) presented localized hematoma and 2.2% (1) presented localized edema.
IOERT boost in breast cancer treatment during BCS is a safe option with low chronic toxicity. The recurrence rates are comparable to published data and emphasize that IOERT as boost is an effective treatment.
保乳手术后给予肿瘤床剂量加量已被证明可降低局部复发率。术中电子放射治疗（IOERT）提供了一种替代方法来给予加量，具有许多优点，例如直接可视化肿瘤床、减少分次内和分次间运动以及减少就诊次数。我们研究的目的是评估我们的患者在接受 IOERT 加量后慢性毒性和长期结果。
我们前瞻性分析了 2013 年 7 月至 2020 年 6 月期间在我们机构接受 IOERT 加量治疗的 46 例患者，这些患者在保乳手术期间接受 IOERT 加量并连续接受全乳房照射。42 例患者给予 10-12Gy 加量，4 例患者给予 20Gy 加量。进行了总生存、局部复发和远处进展的分析。通过 CTCAE 4.0 评估急性和慢性毒性。
中位年龄为 64.5 岁（40-90）。中位随访时间为 62 个月（4-86）。我们没有局部复发，但有 2 例患者（4.3%）出现远处复发。平均病理肿瘤大小为 16mm（6-52）。84.8%（39）的患者为浸润性导管癌。组织学分级 II 级占 52.2%（24）。Luminal A 样占 52.2%（24），Luminal B 样占 21.7%（10），HER2 阳性占 13%（6），三阴性占 13%（6）。未观察到 3-4 级慢性毒性。13%（6）的患者出现 1-2 级纤维化，4.3%（2）的患者出现脂肪坏死，6.5%（3）的患者出现血清肿，4.3%（2）的患者出现局部疼痛，2.2%（1）的患者出现局部血肿，2.2%（1）的患者出现局部水肿。
BCS 期间乳腺癌治疗中的 IOERT 加量是一种安全的选择，慢性毒性低。复发率与已发表的数据相当，强调了 IOERT 作为加量是一种有效的治疗方法。
