Chung Eric M, Nguyen Anthony T, Mirhadi Amin, Steers Jennifer M, Phillips Tiffany, Atkins Katelyn M, Burnison Michele, Shiao Stephen L, Kamrava Mitchell
Department of Radiation Oncology, Cedars-Sinai Medical Center, Los Angeles, CA; Cedars-Sinai Medical Center, Samuel Oschin Comprehensive Cancer Institute, Los Angeles, CA.
Department of Radiation Oncology, Cedars-Sinai Medical Center, Los Angeles, CA; Cedars-Sinai Medical Center, Samuel Oschin Comprehensive Cancer Institute, Los Angeles, CA.
Brachytherapy. 2023 May-Jun;22(3):361-367. doi: 10.1016/j.brachy.2023.02.006. Epub 2023 Mar 28.
Accelerated partial breast irradiation (APBI) delivered with high-dose-rate brachytherapy is a standard of care treatment typically delivered over 10 fractions. The TRIUMPH-T multi-institutional study recently demonstrated promising results using a shorter three fraction regimen, however there are limited additional published series using this regimen. Here, we report our experience and outcomes for patients treated as per the TRIUMPH-T regimen.
This study was a retrospective single-institution analysis of patients who underwent lumpectomy followed by APBI (22.5 Gy in 3 fractions delivered over 2-3 days) using a Strut Adjusted Volume Implant (SAVI) applicator between November 2016 and January 2021. Dose-volume metrics were obtained from the clinically treated plan. Chart review was performed to determine locoregional recurrence and toxicities according to CTCAE v5.0.
Between 2016 and 2021, 31 patients were treated per the TRIUMPH-T protocol. Median followup was 31 months from completion of brachytherapy. There were no acute/late Grade 3 or higher toxicities. Cumulative late Grade 1 and 2 toxicities were seen in 58.1% and 9.7% of patients, respectively. Of note, four patients experienced locoregional recurrence: three ipsilateral breast tumor recurrences and one nodal recurrence. All three ipsilateral breast tumor recurrences occurred in patients who would be classified as "cautionary" based on ASTRO consensus guidelines due to age ≤50, lobular histology, or high grade.
Three-fraction HDR brachytherapy APBI was well-tolerated with no grade 3 or higher toxicities and an acceptably small percentage of grade 2 toxicities. Given the small sample size, the number of recurrences suggests that attention to appropriate patient selection is necessary until more long-term followup data is available.
高剂量率近距离放射治疗的加速部分乳腺照射（APBI）是一种标准的治疗方法，通常分10次进行。TRIUMPH-T多机构研究最近使用更短的三次照射方案取得了有前景的结果，然而使用该方案的已发表系列研究有限。在此，我们报告按照TRIUMPH-T方案治疗的患者的经验和结果。
本研究是一项单机构回顾性分析，对2016年11月至2021年1月期间接受保乳手术并使用Strut调整体积植入器（SAVI）施源器进行APBI（22.5 Gy分3次在2 - 3天内给予）的患者进行分析。剂量体积指标从临床治疗计划中获取。根据CTCAE v5.0进行病历审查以确定局部区域复发和毒性反应。
2016年至2021年期间，31例患者按照TRIUMPH-T方案接受治疗。从近距离放射治疗完成起的中位随访时间为31个月。没有3级或更高等级的急性/晚期毒性反应。分别有58.1%和9.7%的患者出现累积晚期1级和2级毒性反应。值得注意的是，4例患者出现局部区域复发：3例同侧乳腺肿瘤复发和1例淋巴结复发。所有3例同侧乳腺肿瘤复发均发生在根据美国放射肿瘤学会（ASTRO）共识指南因年龄≤50岁、小叶组织学或高级别而被归类为“警示性”的患者中。
三次照射的高剂量率近距离放射治疗APBI耐受性良好，没有3级或更高等级的毒性反应，2级毒性反应的发生率也在可接受范围内。鉴于样本量较小，复发数量表明在获得更多长期随访数据之前，有必要关注合适的患者选择。
