Jazmati Danny, Bölke Edwin, Halfmann Kati, Tamaskovics Bálint, Ruckhäberle Eugen, Fehm Tanja, Hoffmann Jürgen, Krug David, Nestle Krämling Carolin, Corradini Stefanie, Budach Wilfried, Mohrmann Svjetlana, Haussmann Jan, Matuschek Christiane
Department of Radiation Oncology, Heinrich Heine University, 40225 Duesseldorf, Germany.
Department of Gynecology & Obstetrics, Heinrich-Heine University Dusseldorf, 40225 Duesseldorf, Germany.
Cancers (Basel). 2022 Jul 26;14(15):3636. doi: 10.3390/cancers14153636.
Background/Aims: Due to its favorable dose distribution and targeting of the region at highest risk of recurrence due to direct visualization of tumor bed, intraoperative electron radiation therapy (IOERT) is used as part of a breast-conserving treatment approach. The aim of this study was to analyze tumor control and survival, as well as the toxicity profile, and cosmetic outcomes in patients irradiated with an IOERT boost for breast cancer. Materials and Methods: 139 Patients treated at our institution between January 2010 and January 2015 with a single boost dose of 10 Gy to the tumor bed during breast-conserving surgery followed by whole-breast irradiation were retrospectively analyzed. Results: 139 patients were included in this analysis. The median age was 54 years (range 28−83 years). The preferred surgical strategy was segmental resection with sentinel lymphonodectomy (66.5%) or axillary dissection (23.1%). Regarding adjuvant radiotherapy, the vast majority received 5 × 1.8 Gy to 50.4 Gy. At a median follow-up of 33.6 months, recurrence-free and overall survival were 95.5% and 94.9%, respectively. No patient developed an in-field recurrence. Seven patients (5.0%) died during the follow-up period, including two patients due to disease recurrence (non-in-field). High-grade (CTCAE > 2) perioperative adverse events attributable to IOERT included wound healing disorder (N = 1) and hematoma (N = 1). High-grade late adverse events (LENT-SOMA grade III) were reported only in one patient with fat necrosis. Low-grade late adverse events (LENT-SOMA grade I-II) included pain (18.0%), edema (10.5%), fibrosis (21%), telangiectasia (4.5%) and pigmentation change (23.0%). The mean breast retraction assessment score was 1.66 (0−6). Both patients and specialists rated the cosmetic result “excellent/good” in 84.8% and 87.9%, respectively. Conclusion: Our study reports favorable data on the cosmetic outcome as well as the acute and early long-term tolerability for patients treated with an IOERT boost. Our oncologic control rates are comparable to the previous literature. However, prospective investigations on the role of IOERT in comparison to other boost procedures would be desirable.
背景/目的：术中电子线放射治疗（IOERT）因其剂量分布良好且能直接观察瘤床，针对复发风险最高的区域进行靶向治疗，故而被用作保乳治疗方法的一部分。本研究旨在分析接受IOERT加量照射的乳腺癌患者的肿瘤控制情况、生存率、毒性反应以及美容效果。材料与方法：回顾性分析了2010年1月至2015年1月期间在本机构接受治疗的139例患者，这些患者在保乳手术期间接受了单次10 Gy的瘤床加量照射，随后进行全乳照射。结果：本分析纳入了139例患者。中位年龄为54岁（范围28 - 83岁）。首选的手术策略是区段切除加前哨淋巴结活检（66.5%）或腋窝清扫（23.1%）。关于辅助放疗，绝大多数患者接受了5×1.8 Gy至50.4 Gy的照射。中位随访33.6个月时，无复发生存率和总生存率分别为95.5%和94.9%。无患者发生野内复发。7例患者（5.0%）在随访期间死亡，其中2例死于疾病复发（非野内复发）。IOERT导致的高级别（CTCAE＞2）围手术期不良事件包括伤口愈合障碍（N = 1）和血肿（N = 1）。仅1例发生脂肪坏死的患者报告有高级别晚期不良事件（LENT - SOMAⅢ级）。低级别晚期不良事件（LENT - SOMAⅠ - Ⅱ级）包括疼痛（18.0%）、水肿（10.5%）、纤维化（21%）、毛细血管扩张（4.5%）和色素沉着改变（23.0%）。乳房回缩评估平均评分为1.66（0 - 6）。患者和专家分别将美容效果评为“优秀/良好”的比例为84.8%和87.9%。结论：我们的研究报告了关于接受IOERT加量照射患者的美容效果以及急性和早期长期耐受性方面的良好数据。我们的肿瘤控制率与既往文献相当。然而，与其他加量程序相比，关于IOERT作用的前瞻性研究是很有必要的。
