Chitapanarux Imjai, Nobnop Wannapha, Onchan Wimrak, Klunklin Pitchayaponne, Nanna Thongtra, Sitathanee Chomporn, Kulpisitthicharoen Sutthisak, Sripan Patumrat
Division of Radiation Oncology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
Northern Thai Research Group of Radiation Oncology (NTRG-RO), Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
Front Oncol. 2023 Mar 17;13:1122093. doi: 10.3389/fonc.2023.1122093. eCollection 2023.
We prospectively investigated the acute toxicities focusing on skin and hematologic function in breast cancer patients who received hypofractionated whole breast irradiation with simultaneous integrated boost (HF-WBI-SIB) with helical tomotherapy (HT), with or without regional nodal irradiation (RNI).
The dose of WBI and RNI was 42.4 Gy in 16 fractions. Tumor bed was prescribed to 49.6 Gy in 16 fractions simultaneously. The association between the worst grade of acute toxicities during treatment and receiving RNI was analyzed. The integral dose to the whole body between the two groups was also compared.
Between May 2021 and May 2022, 85 patients were enrolled; 61 patients received HF-WBI-SIB only (71.8%) and 24 patients (28.2%) received HF-WBI-SIB with RNI. Grade 2 acute skin toxicity was found in 1.2%. The most frequent grade 2 or more hematologic toxicity was leukopenia, which occurred in 4.8% and 11% in the 2nd and 3rd week, respectively. Mean whole body integral dose was significantly higher in patients treated with RNI compared to patients treated without RNI: 162.8 ± 32.8 . 120.3 ± 34.7 Gy-L (p-value < 0.001). There was no statistically significant difference in acute grade 2 or more skin and hematologic toxicities between the two groups.
HF-WBI-SIB with or without RNI is feasible with acceptable acute skin and hematologic toxicities. RNI and whole body integral dose were not associated with these acute toxicities.
我们前瞻性地研究了接受螺旋断层放疗（HT）进行大分割全乳照射同步整合加量（HF-WBI-SIB）的乳腺癌患者的急性毒性，重点关注皮肤和血液学功能，无论是否进行区域淋巴结照射（RNI）。
全乳照射（WBI）和区域淋巴结照射（RNI）的剂量为42.4 Gy，分16次照射。肿瘤床同时给予16次照射，总剂量为49.6 Gy。分析治疗期间急性毒性的最差等级与接受区域淋巴结照射（RNI）之间的关联。还比较了两组之间的全身积分剂量。
2021年5月至2022年5月，共纳入85例患者；61例患者仅接受HF-WBI-SIB（71.8%），24例患者（28.2%）接受HF-WBI-SIB联合区域淋巴结照射（RNI）。2级急性皮肤毒性发生率为1.2%。最常见的2级及以上血液学毒性是白细胞减少，分别在第2周和第3周发生率为4.8%和11%。接受区域淋巴结照射（RNI）的患者的平均全身积分剂量显著高于未接受区域淋巴结照射（RNI）的患者：162.8±32.8、120.3±34.7 Gy-L（p值<0.001）。两组之间2级及以上急性皮肤和血液学毒性无统计学显著差异。
无论是否进行区域淋巴结照射（RNI），HF-WBI-SIB在急性皮肤和血液学毒性可接受的情况下是可行的。区域淋巴结照射（RNI）和全身积分剂量与这些急性毒性无关。
