Hardy-Abeloos Camille, Xiao Julie, Oh Cheongeun, Barbee David, Perez Carmen A, Oratz Ruth, Schnabel Freya, Axelrod Deborah, Guth Amber, Braunstein Lior Z, Khan Atif, Choi J Isabelle, Gerber Naamit
Department of Radiation Oncology, NYU School of Medicine, New York, NY, USA.
Department of Medical Oncology, NYU School of Medicine, New York, NY, USA.
Breast Cancer Res Treat. 2023 Feb;198(1):43-51. doi: 10.1007/s10549-022-06853-4. Epub 2023 Jan 5.
Breast reirradiation (reRT) after breast conserving surgery (BCS) has emerged as a viable alternative to mastectomy for women presenting with recurrent or new primary breast cancer. There are limited data on safety of different fractionation regimens. This study reports safety and efficacy among women treated with repeat BCS and reRT.
Patients who underwent repeat BCS followed by RT from 2015 to 2021 at 2 institutions were analyzed. Univariate logistic regression models were used to identify predictors of acute and late toxicities. Kaplan-Meier estimates were used to evaluate overall survival (OS), distant metastasis-free survival (DMFS) and locoregional recurrence-free survival (LR-RFS).
Sixty-six patients were reviewed with median follow-up of 16 months (range: 3-60 months). At time of first recurrence, 41% had invasive carcinoma with a ductal carcinoma in situ (DCIS) component, 41% had invasive carcinoma alone and 18% had DCIS alone. All were clinically node negative. For the reirradiation course, 95% received partial breast irradiation (PBI) (57.5% with 1.5 Gy BID; 27% with 1.8 Gy daily; 10.5% with hypofractionation), and 5% received whole breast irradiation (1.8-2 Gy/fx), all of whom had received PBI for initial course. One patient experienced grade 3 fibrosis, and one patient experienced grade 3 telangiectasia. None had grade 4 or higher late adverse events. We found no association between the fractionation of the second course of RT or the cumulative dose (measured as EQD2) with acute or late toxicity. At 2 years, OS was 100%, DMFS was 91.6%, and LR-RFS was 100%.
In this series of patients with recurrent or new primary breast cancer, a second breast conservation surgery followed by reirradiation was effective with no local recurrences and an acceptable toxicity profile across a range of available fractionation regimens at a median follow up of 16 months. Longer follow up is required.
保乳手术（BCS）后进行乳房再放疗（reRT）已成为复发性或新发原发性乳腺癌女性乳房切除术的一种可行替代方案。关于不同分割方案安全性的数据有限。本研究报告了接受重复BCS和reRT治疗的女性的安全性和疗效。
分析了2015年至2021年在2家机构接受重复BCS后再进行放疗的患者。使用单因素逻辑回归模型来确定急性和晚期毒性的预测因素。采用Kaplan-Meier估计法评估总生存期（OS）、无远处转移生存期（DMFS）和无局部区域复发生存期（LR-RFS）。
共纳入66例患者，中位随访时间为16个月（范围：3 - 60个月）。首次复发时，41%为伴有导管原位癌（DCIS）成分的浸润性癌，41%为单纯浸润性癌，18%为单纯DCIS。所有患者临床检查均无淋巴结转移。在再放疗疗程中，95%接受了部分乳腺照射（PBI）（57.5%为每日两次，每次1.5 Gy；27%为每日1.8 Gy；10.5%为大分割照射），5%接受了全乳照射（每次1.8 - 2 Gy），所有接受全乳照射的患者初始疗程均接受过PBI。1例患者出现3级纤维化，1例患者出现3级毛细血管扩张。无4级或更高等级的晚期不良事件。我们发现再放疗第二疗程的分割方式或累积剂量（以等效剂量2 [EQD2] 衡量）与急性或晚期毒性之间无关联。2年时，OS为100%，DMFS为91.6%，LR-RFS为100%。
在这组复发性或新发原发性乳腺癌患者中，中位随访16个月时进行第二次保乳手术并再放疗有效，无局部复发，且在一系列可用分割方案中具有可接受的毒性特征。需要更长时间的随访。
