Chaffai I, Cao K, Kissel M, El Ayachy R, Aboudaram A, Fourquet A, Kirova Y
Département d'oncologie radiothérapie, institut Curie, 75005 Paris, France.
Département d'oncologie radiothérapie, institut Curie, 75005 Paris, France.
Cancer Radiother. 2022 Jun;26(4):542-546. doi: 10.1016/j.canrad.2021.07.036. Epub 2021 Aug 26.
Moderate hypofractionated radiotherapy has become routine practice for a selected population of patients treated for early-stage breast cancer. In April 2020, the Fast Forward (FF) study was published which introduced another extreme hypofractionated radiotherapy regimen in five sessions over a week. The aim of this work is to evaluate the population of first patients in whom this regimen was used in our department, as well as the results in terms of early toxicity.
We retrospectively analysed all the patients treated in our department according to the Fast Forward protocol after establishing an institutional consensus regarding the selection of patients with breast cancer without indication for lymph node irradiation. All patients received breast-only irradiation at a total dose of 26Gy in five fractions according to protocol. All patients were treated by modern conformational techniques with planning large volume coverage between 95 and 100%. Acute toxicity of the treatment was assessed using the NCI CTC v4.0 scale and the general condition was assessed according to the WHO classification.
Between August 2020 and May 2021, 30 patients were included, treated on the breast alone without complement on the tumour bed or irradiation of the lymph node areas. The median age of the patients was 80years (range: 60-85years) with performance status 2 in 27 cases (89%). Only one patient had metastatic disease (3%), one patient presented locally advanced and 28 (94%) patients had early stage disease. Three patients (10%) were treated in dorsal decubitus according to the "field in the field" technique and 27 patients (90%) in isocentric lateral decubitus, which made it possible to avoid the organs at risk such as the heart (average dose of less than 1Gy) and the lungs. The early toxicity observed was grade I radio dermatitis in 8 patients (27%). No grade 2 and 3 toxicity, as well as radiation-induced pain or lymphedema were observed.
The results of this series of patients treated with hypofractionated radiotherapy according to the Fast Forward protocol on the breast alone with adapted techniques show that the protocol is feasible, with little early toxicity but a greater follow-up is necessary to assess long-term toxicity.
对于部分早期乳腺癌患者，适度的低分割放疗已成为常规治疗方法。2020年4月，《快速前进》（FF）研究发表，该研究介绍了另一种超分割放疗方案，即在一周内分五次进行。本研究的目的是评估我院首例采用该方案治疗的患者群体，以及早期毒性方面的结果。
在就无淋巴结照射指征的乳腺癌患者选择达成机构共识后，我们回顾性分析了我院按照《快速前进》方案治疗的所有患者。所有患者均按照方案接受仅乳房照射，总剂量为26Gy，分五次进行。所有患者均采用现代适形技术治疗，计划靶区体积覆盖率在95%至100%之间。使用美国国立癌症研究所（NCI）不良事件通用术语标准第4.0版（CTC v4.0）评估治疗的急性毒性，并根据世界卫生组织（WHO）分类评估一般状况。
2020年8月至2021年5月期间，纳入30例患者，仅对乳房进行治疗，未对瘤床进行补充治疗或照射淋巴结区域。患者的中位年龄为80岁（范围：60 - 85岁），27例（89%）患者的体能状态为2级。仅1例患者有转移疾病（3%），1例患者为局部晚期，28例（94%）患者为早期疾病。3例患者（10%）根据“野中野”技术采用仰卧位治疗，27例患者（90%）采用等中心侧卧位治疗，这使得能够避免心脏（平均剂量小于1Gy）和肺部等危及器官。观察到的早期毒性为8例患者（27%）出现I级放射性皮炎。未观察到2级和3级毒性，以及放射性疼痛或淋巴水肿。
本系列患者采用《快速前进》方案对乳房进行低分割放疗并结合适当技术的结果表明，该方案可行，早期毒性较小，但需要更长时间的随访以评估长期毒性。
