The Royal Marsden NHS Foundation Trust, Sutton, UK; Institute of Cancer Research, London, UK.
Institute of Cancer Research, London, UK.
Clin Oncol (R Coll Radiol). 2023 Sep;35(9):e469-e477. doi: 10.1016/j.clon.2023.06.006. Epub 2023 Jun 9.
For patients with locally advanced primary/recurrent breast cancer, radiotherapy is an effective treatment for locoregional control. 36 Gy in 6 Gy once-weekly fractions is a commonly used schedule, but there are no data comparing local control and toxicity between 36 Gy delivered once-weekly versus accelerated schedules of multiple 6 Gy fractions per week. This retrospective study compared local control rates and acute and late toxicity in patients undergoing 30-36 Gy in 6 Gy fractions over 6 weeks versus more accelerated schedules over 2-3 weeks for an unresected breast cancer.
Patients who received 30-36 Gy in 6 Gy fractions to an unresected breast cancer ± involved lymph nodes between December 2011 and August 2020 were identified. Patients were grouped into once-weekly versus accelerated fractionation schedules. Response rates, local control and toxicity data were analysed.
In total, 109 patients were identified. The median follow-up duration was 46 months. Forty-seven patients (43%) received once-weekly fractions and 62 patients (57%) received accelerated fractionation schedules. There were no significant differences in baseline tumour characteristics between the groups. Eighty-seven per cent of patients had an objective (complete or partial) response (81% in the once-weekly group; 91% in the accelerated group). The median time to local progression was 23.5 months overall (95% confidence interval 17.8-29.2); 23.5 months (95% confidence interval 18.8-28.1) in the once-weekly group and 19.0 months (95% confidence interval 7.0-31.1) in the accelerated group (P = 0.99). Acute toxicity of any grade occurred in 75% of patients (76% in the once-weekly group; 74% in the accelerated group) and grade 3 toxicity occurred in 7% of patients (7% in the once-weekly group; 8% in the accelerated group). There were no associations between the groups and acute or late toxicity grade (P = 0.78 and P = 0.26, respectively), although one grade 4 late toxicity (skin radionecrosis) occurred in a patient who received five fractions a week and therefore this regimen is not recommended. Study limitations included a lack of statistical power analysis, the necessary grouping of all accelerated patients for analysis and a high rate of censored data.
There were no apparent differences in response rate, time to local progression or toxicity between patients who received 30-36 Gy in 6 Gy fractions once-weekly compared with twice-weekly as palliative treatment for locally advanced breast cancer. This regimen appears to be a safe alternative and may be preferred by patients.
对于局部晚期原发性/复发性乳腺癌患者，放射治疗是局部区域控制的有效治疗方法。36 Gy 分 6 Gy 每周一次的分割是常用的方案，但尚无数据比较每周一次分割与每周多次 6 Gy 分割的加速方案之间的局部控制率和毒性。这项回顾性研究比较了未切除乳腺癌患者接受 30-36 Gy 分 6 Gy 每周一次与 2-3 周内更加速方案的局部控制率以及急性和迟发性毒性。
确定了 2011 年 12 月至 2020 年 8 月期间接受未切除乳腺癌 ±受累淋巴结 30-36 Gy 分 6 Gy 治疗的患者。将患者分为每周一次分割与加速分割方案组。分析了反应率、局部控制率和毒性数据。
共确定了 109 例患者。中位随访时间为 46 个月。47 例（43%）患者接受每周一次分割，62 例（57%）患者接受加速分割方案。两组患者的基线肿瘤特征无显著差异。87%的患者有客观（完全或部分）缓解（每周一次组为 81%；加速组为 91%）。总体局部进展中位时间为 23.5 个月（95%置信区间为 17.8-29.2）；每周一次组为 23.5 个月（95%置信区间为 18.8-28.1），加速组为 19.0 个月（95%置信区间为 7.0-31.1）（P=0.99）。任何级别急性毒性的发生率为 75%（每周一次组为 76%；加速组为 74%），3 级毒性发生率为 7%（每周一次组为 7%；加速组为 8%）（P=0.78）。两组与急性或迟发性毒性分级之间无关联（P=0.26），尽管一名患者每周接受 5 次分割时发生 1 例 4 级迟发性毒性（皮肤放射性坏死），因此不推荐该方案。研究局限性包括缺乏统计学功效分析、所有加速患者分组进行分析以及大量删失数据。
对于局部晚期乳腺癌的姑息性治疗，接受每周一次 30-36 Gy 分 6 Gy 与每周两次相比，在反应率、局部进展时间或毒性方面无明显差异。这种方案似乎是一种安全的替代方案，可能更受患者青睐。
