Miljanic Mihailo, Nwachukwu Chika, Rahimi Assal
Department of Radiation Oncology at University of Texas Southwestern Medical Center, 2280 Inwood Road, Dallas, TX, USA.
J Cancer Res Clin Oncol. 2023 Nov;149(17):15553-15559. doi: 10.1007/s00432-023-05053-x. Epub 2023 Aug 31.
This case series and literature review aims to investigate the efficacy and safety of definitive ablative radiation therapy as a treatment modality for non-operable patients with early stage breast cancer. We present two cases demonstrating the potential of this approach to achieve durable responses.
We assessed the long-term response of two non-operable patients diagnosed with Stage II (cT2N0M) and Stage IA (T1bN0M0) invasive ductal carcinoma (IDC), who were deemed unfit for surgery due to significant co-morbid conditions. Definitive ablative radiation therapy was administered using stereotactic partial breast irradiation with ablative doses delivered in either a single fraction or two fractions. Serial imaging was conducted to assess treatment response and monitor adverse events.
Both patients exhibited notable treatment responses following definitive ablative radiation therapy. The first patient, an 84-year-old woman, experienced a 69% reduction in tumor size over a follow-up period exceeding 2 years. The second patient, an 87-year-old woman, achieved complete resolution of disease on imaging, with no signs of progression even 26 month post-treatment. Both patients tolerated the treatment well, without significant treatment-related adverse events.
Our case series suggests that definitive ablative radiation therapy may serve as a safe and effective treatment option for non-operable patients with early stage breast cancer. The observed durable treatment responses and minimal toxicity support the potential of this approach. Furthermore, a longer interval between ablative radiation therapy and surgery may enhance treatment response, potentially leading to increased complete pathologic response rates.
本病例系列及文献综述旨在研究根治性消融放疗作为早期乳腺癌不可手术患者治疗方式的有效性和安全性。我们展示两例病例，以证明这种方法实现持久缓解的潜力。
我们评估了两名诊断为II期（cT2N0M）和IA期（T1bN0M0）浸润性导管癌（IDC）的不可手术患者的长期反应，这两名患者因严重合并症被认为不适合手术。采用立体定向部分乳腺照射，以单次分割或两次分割的方式给予消融剂量，进行根治性消融放疗。进行系列成像以评估治疗反应并监测不良事件。
两名患者在根治性消融放疗后均表现出显著的治疗反应。第一名患者是一名84岁女性，在超过2年的随访期内肿瘤大小减少了69%。第二名患者是一名87岁女性，影像学上疾病完全缓解，即使在治疗后26个月也没有进展迹象。两名患者对治疗耐受性良好，没有明显的与治疗相关的不良事件。
我们的病例系列表明，根治性消融放疗可能是早期乳腺癌不可手术患者的一种安全有效的治疗选择。观察到的持久治疗反应和最小毒性支持了这种方法的潜力。此外，消融放疗与手术之间较长的间隔时间可能会增强治疗反应，有可能提高完全病理缓解率。
