Dejonckheere Cas Stefaan, Abramian Alina, Lindner Kira, Bachmann Anne, Layer Katharina, Anzböck Teresa, Layer Julian Philipp, Sarria Gustavo Renato, Scafa Davide, Koch David, Leitzen Christina, Kaiser Christina, Faridi Andree, Schmeel Leonard Christopher
Department of Radiation Oncology, University Hospital Bonn, 53127 Bonn, Germany.
Department of Gynaecology, Division of Senology, University Hospital Bonn, 53127 Bonn, Germany.
J Clin Med. 2023 Jun 22;12(13):4212. doi: 10.3390/jcm12134212.
This study aimed to differentially assess the frequency and severity of late radiation-induced toxicity following adjuvant whole-breast irradiation for early breast cancer with conventional fractionation (CF) and moderate hypofractionation (mHF). Patients recruited in a previous randomised controlled trial comparing acute toxicity between CF and mHF without disease recurrence were included in a post hoc analysis. Spectrophotometric and ultrasonographic examinations were performed for an objective evaluation and subsequent comparison of long-term skin toxicity. Furthermore, patient- and clinician-reported outcomes were recorded. Sixty-four patients with a median age of 58 (37-81) years were included. The median follow-up was 57 (37-73) months. A total of 55% underwent CF and 45% mHF. A total of 52% received a sequential boost to the tumour bed. A significant decrease in mean L* ( = 0.011) and an increase in a* ( = 0.040) and b* values ( < 0.001) were observed, indicating hyperpigmentation. In comparison with the non-irradiated breast, there was a significant increase in both cutis (+14%; < 0.001) and subcutis (+17%; = 0.011) thickness, significantly more pronounced in CF patients ( = 0.049). In CF patients only, a sequential boost significantly increased the local cutis thickness and oedema compared to non-boost regions in the same breast ( = 0.001 and < 0.001, respectively). mHF objectively resulted in reduced long-term skin toxicity compared to CF. A sequential boost increased the local fibrosis rate in CF, but not in mHF. This might explain the subjectively reported better cosmetic outcomes in patients receiving mHF and reinforces the rationale for favouring mHF as the standard of care.
本研究旨在通过常规分割（CF）和适度低分割（mHF），对早期乳腺癌辅助性全乳照射后迟发性放射性毒性的频率和严重程度进行差异评估。在一项先前的随机对照试验中招募的、比较CF和mHF之间的急性毒性且无疾病复发的患者被纳入事后分析。进行了分光光度法和超声检查，以客观评估并随后比较长期皮肤毒性。此外，还记录了患者和临床医生报告的结果。纳入了64例患者，中位年龄为58（37 - 81）岁。中位随访时间为57（37 - 73）个月。共有55%的患者接受CF，45%接受mHF。共有52%的患者接受了瘤床追加照射。观察到平均L值显著降低（ = 0.011），a值（ = 0.040）和b*值增加（ < 0.001），表明有色素沉着。与未照射的乳房相比，真皮层（增加14%； < 0.001）和皮下组织（增加17%； = 0.011）厚度均显著增加，在CF患者中更为明显（ = 0.049）。仅在CF患者中，与同一乳房的未追加照射区域相比，追加照射显著增加了局部真皮层厚度和水肿（分别为 = 0.001和 < 0.001）。与CF相比，mHF客观上导致长期皮肤毒性降低。追加照射增加了CF患者的局部纤维化率，但在mHF患者中未增加。这可能解释了接受mHF治疗的患者主观报告的美容效果更好，并强化了支持将mHF作为标准治疗方案的理由。
