Department of Radiation Oncology, Rhode Island Hospital, Brown University, Providence, RI; Department of Radiation Oncology, Tufts Medical Center, Tufts University, Boston, MA.
Department of Radiation Oncology, Rhode Island Hospital, Brown University, Providence, RI; Department of Radiation Oncology, Tufts Medical Center, Tufts University, Boston, MA.
Brachytherapy. 2021 May-Jun;20(3):631-637. doi: 10.1016/j.brachy.2021.01.002. Epub 2021 Feb 26.
The noninvasive image-guided breast brachytherapy (NIBB) technique is a novel noninvasive yet targeted method for accelerated partial breast irradiation. We established a multi-institutional registry to evaluate the toxicity and efficacy of this technique across various practice settings.
Institutions using the NIBB technique were invited to participate. Data for acute/late toxicity, cosmetic outcome, and tumor recurrence were collected. Toxicity and cosmetic outcome were graded based on the Common Terminology Criteria for Adverse Events version 3.0 and NRG/Radiation Therapy Oncology Group scale, respectively. Treatment variables were analyzed for association with outcomes.
A total of 252 patients from eight institutions were analyzed. The median age was 69 years. The mean tumor size was 1.1 cm (0.1-4.0 cm). Treatment was delivered 10 fractions (34-36 Gy) in 75% and five fractions (28.5 Gy) in 22%. B.i.d. fractionation was used in 9%. Acute radiation dermatitis was Grade 0-1, 2, and 3 in 77%, 19%, and 4%, respectively. One hundred ninety-one patients with a median followup of 18 months (4-72 months) were evaluable for late outcomes. Late toxicity Grades 2 and 3 were observed in 8.8% and 1%, respectively. Cosmetic outcome was excellent, good, and fair/poor in 62%, 36%, and 2%, respectively. B.i.d. fractionation was associated with higher acute and late toxicity. Second-generation applicators were associated with lower late toxicity and better cosmetic outcome. Actuarial freedom from ipsilateral breast tumor recurrence and true recurrence were 98.3% and 98.3% at 2 years and 90.9% and 95.4% at 5 years, respectively.
Accelerated partial breast irradiation using NIBB was well tolerated with a low rate of acute and late toxicity across various practice settings. Ipsilateral breast tumor recurrence and cosmetic outcomes were favorable. b.i.d. fractionation was associated with higher toxicity. Longer followup is needed to confirm late endpoints.
无创影像引导下的乳腺近距离放疗（NIBB）技术是一种新的非侵入性靶向加速部分乳腺放疗方法。我们建立了一个多机构注册处，以评估该技术在不同实践环境中的毒性和疗效。
邀请使用 NIBB 技术的机构参与。收集急性/晚期毒性、美容效果和肿瘤复发的数据。毒性和美容效果分别根据通用不良事件术语标准第 3.0 版和 NRG/放射治疗肿瘤学组量表进行分级。分析治疗变量与结局的关系。
共分析了来自 8 个机构的 252 名患者。中位年龄为 69 岁。平均肿瘤大小为 1.1cm（0.1-4.0cm）。治疗采用 10 个分次（34-36Gy），22%采用 5 个分次（28.5Gy），9%采用 b.i.d. 分割。急性放射性皮炎为 0-1、2 和 3 级的比例分别为 77%、19%和 4%。191 名患者中位随访 18 个月（4-72 个月），可评估晚期结果。2 级和 3 级晚期毒性分别为 8.8%和 1%。美容效果为优、良和差/差的比例分别为 62%、36%和 2%。b.i.d. 分割与更高的急性和晚期毒性相关。第二代施源器与较低的晚期毒性和更好的美容效果相关。2 年时同侧乳腺肿瘤复发和真实复发的无复发生存率分别为 98.3%和 98.3%，5 年时分别为 90.9%和 95.4%。
在各种实践环境中，使用 NIBB 的加速部分乳腺放疗耐受性良好，急性和晚期毒性发生率低。同侧乳腺肿瘤复发和美容效果良好。b.i.d. 分割与更高的毒性相关。需要更长的随访时间来确认晚期终点。
