Department of Radiation Oncology, Antoine Lacassagne Cancer Center, University of Cote d'Azur, Nice, France.
Department of Radiation Oncology, Antoine Lacassagne Cancer Center, University of Cote d'Azur, Nice, France.
Int J Radiat Oncol Biol Phys. 2021 Sep 1;111(1):56-67. doi: 10.1016/j.ijrobp.2021.03.052. Epub 2021 Apr 6.
PURPOSE: Accelerated partial breast irradiation (APBI) represents a validated technique for low-risk breast cancer. Recently, ultra-APBI (uAPBI) using fewer than 5 fractions was described in the literature. We compared clinical outcomes and late toxicity after APBI or uAPBI in older patients. METHODS AND MATERIALS: Two cohorts of older patients (aged ≥70 years) with low-risk breast cancer treated with APBI (interstitial brachytherapy) were analyzed retrospectively. A total dose of 34 Gy in10 fractions (APBI) or 16 Gy in 1 fraction (uAPBI) was delivered from 2004 to 2012 and from 2013 to 2018, respectively. Oncologic outcome analyzed the cumulative incidence of local relapse, regional relapse, and distant metastases with disease-free survival, cause-specific survival, and overall survival. Late toxicity and cosmetic results were investigated. RESULTS: One hundred fifty-seven patients (APBI, n = 109 patients; uAPBI, n = 48 patients) underwent APBI according to the same selection criteria. Apart from the median follow-up (97 vs 72 months for APBI and uAPBI; P < .002), no significant difference was noted between the 2 groups. Regarding 6-year oncologic outcome, no significant difference was observed between APBI and uAPBI for local recurrence (1.3% vs 0%; P = .4), regional recurrence (2.5% vs 2.3%; P = .9), distant metastases (4.3% vs. 2.4%; P = .6), disease-free survival (85.2% vs. 82.2%; P = .8), cause-specific survival (96.7% vs. 96.2%; P = .9), and overall survival (86.7% vs. 82.2%; P = .7). Regarding late toxicity, no significant difference was observed between APBI and uAPBI (total complication number, 45 vs 33%; P = .173) with only grade 1 (88.4% vs. 95%) and grade 2 (11.6% vs. 5%) late toxicities (P = .677). Similarly, no significant difference was observed for excellent/good cosmetic results between the 2 cohorts (P = .98). CONCLUSIONS: We report the first study comparing APBI versus uAPBI in a cohort of older patients with low-risk breast cancer. No significant difference was found between the 2 treatment groups regarding oncologic outcome, late toxicity, and cosmetic result. uAPBI based on a single fraction of brachytherapy represents an attractive option for therapeutic de-escalation in older patients with breast cancer.
目的：加速部分乳房照射（APBI）是一种针对低危乳腺癌的有效技术。最近，文献中描述了使用少于 5 个分次的超 APBI（uAPBI）。我们比较了高龄患者接受 APBI 或 uAPBI 的临床结果和晚期毒性。
方法和材料：回顾性分析了两组接受 APBI（间质近距离放疗）治疗的高龄（≥70 岁）低危乳腺癌患者。从 2004 年至 2012 年，采用 34 Gy 10 次（APBI）或 16 Gy 1 次（uAPBI）的总剂量，从 2013 年至 2018 年。肿瘤学结果分析局部复发、区域复发和远处转移的累积发生率，包括无病生存率、疾病特异性生存率和总生存率。调查了晚期毒性和美容效果。
结果：157 例患者（APBI，n=109 例；uAPBI，n=48 例）根据相同的选择标准接受 APBI。除中位随访时间（APBI 为 97 个月，uAPBI 为 72 个月；P<0.002）外，两组间无显著差异。6 年肿瘤学结果方面，APBI 和 uAPBI 的局部复发（1.3%比 0%；P=0.4）、区域复发（2.5%比 2.3%；P=0.9）、远处转移（4.3%比 2.4%；P=0.6）、无病生存率（85.2%比 82.2%；P=0.8）、疾病特异性生存率（96.7%比 96.2%；P=0.9）和总生存率（86.7%比 82.2%；P=0.7）无显著差异。晚期毒性方面，APBI 和 uAPBI 无显著差异（总并发症数，45%比 33%；P=0.173），仅为 1 级（88.4%比 95%）和 2 级（11.6%比 5%）晚期毒性（P=0.677）。同样，两组间美容效果的优秀/良好比例无显著差异（P=0.98）。
结论：我们报告了第一项比较 APBI 与 uAPBI 在低危乳腺癌高龄患者中的研究。两组患者在肿瘤学结果、晚期毒性和美容效果方面无显著差异。基于单次近距离放疗的 uAPBI 为乳腺癌老年患者的治疗降级提供了一种有吸引力的选择。
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