Chen Kuan-Wen, Hsu Hsiu-Ting, Lin Jia-Fu, Yeh Hui-Ling, Yeh Dah-Cherng, Lin Chin-Yao, Chan Siwa, Hsieh He-Yuan
Department of Radiation Oncology, Taichung Tzu-Chi Hospital, Buddhist Tzu-Chi Medical Foundation, Taichung, Taiwan.
Department of Radiation Oncology, Taichung Veterans General Hospital, Taichung, Taiwan.
Transl Cancer Res. 2020 Jan;9(Suppl 1):S12-S22. doi: 10.21037/tcr.2019.07.19.
Adjuvant whole breast radiotherapy is the standard of care for breast cancer patients after partial mastectomy. Intensity-modulated radiation therapy (IMRT) has been reported to reduce acute toxicities compared to conventional radiotherapy. IMRT with simultaneous integrated boost (SIB) technique can deliver higher doses to tumor bed and irradiate whole breast with a lower dose level to shorten overall treatment duration. This study presents the long-term results of adjuvant IMRT with SIB in elderly breast cancer patients who received partial mastectomy.
From January 2007 to January 2018, 93 elder breast cancer patients (≥65-year-old) who received IMRT with SIB technique after partial mastectomy were reviewed retrospectively. The axillary areas were managed with either sentinel lymph node biopsies or axillary lymph node dissection. The dose to whole breast was 50.4 Gy in 28 fractions in all patients and the dose to tumor bed was 61.6 to 66.4 Gy in 28 fractions. The primary end point is locoregional control. Secondary end points include: overall survival, breast cancer-specific survival, distant-metastases-free survival, disease-free survival, and acute and chronic toxicities.
The median follow-up was 56.1 months. One patient had ipsilateral breast tumor recurrence, 3 patients had regional lymph node recurrence, and 9 patients had distant metastases. Death occurred in 5 patients, including 3 patients died of breast cancer progression. Five-year overall survival is 96.3% and 5-year locoregional recurrence-free survival is 96.4%. The 5-year breast cancer specific survival and 5-year distant metastases-free survival is 97.5% and 87.2%, respectively. Seven patients developed second primary cancer after RT. Eighty-one point seven percent patients had acute grade 1 dermatitis while 18.3% suffered from grade 2 dermatitis. The incidence of grade 1 pneumonitis and grade 1 stomatitis was 4.3% and 8.6%, respectively.
Adjuvant IMRT with SIB technique is a safe and effective treatment strategy for elderly breast cancer patients after partial mastectomy.
辅助性全乳放疗是乳腺癌患者保乳术后的标准治疗方法。据报道，与传统放疗相比，调强放疗（IMRT）可降低急性毒性。采用同步整合加量（SIB）技术的IMRT能够向瘤床给予更高剂量，同时以较低剂量水平照射全乳，从而缩短总治疗时间。本研究呈现了接受保乳术的老年乳腺癌患者辅助性IMRT联合SIB的长期结果。
回顾性分析2007年1月至2018年1月期间93例接受保乳术后采用SIB技术进行IMRT的老年乳腺癌患者（≥65岁）。腋窝区域采用前哨淋巴结活检或腋窝淋巴结清扫进行处理。所有患者全乳剂量为50.4 Gy，分28次照射，瘤床剂量为61.6至66.4 Gy，分28次照射。主要终点是局部区域控制。次要终点包括：总生存、乳腺癌特异性生存、无远处转移生存、无病生存以及急性和慢性毒性。
中位随访时间为56.1个月。1例患者出现同侧乳腺肿瘤复发，3例患者出现区域淋巴结复发，9例患者出现远处转移。5例患者死亡，其中3例死于乳腺癌进展。5年总生存率为96.3%，5年局部区域无复发生存率为96.4%。5年乳腺癌特异性生存率和5年无远处转移生存率分别为97.5%和87.2%。7例患者放疗后发生第二原发性癌症。81.7%的患者出现1级急性皮炎，18.3%的患者出现2级皮炎。1级肺炎和1级口腔炎的发生率分别为4.3%和8.6%。
辅助性IMRT联合SIB技术是老年乳腺癌患者保乳术后安全有效的治疗策略。
