Ratosa Ivica, Montero Angel, Ciervide Raquel, Alvarez Beatriz, García-Aranda Mariola, Valero Jeannette, Chen-Zhao Xin, Lopez Mercedes, Zucca Daniel, Hernando Ovidio, Sánchez Emilio, de la Casa Miguel Angel, Alonso Rosa, Fernandez-Leton Pedro, Rubio Carmen
Division of Radiation Oncology, Institute of Oncology Ljubljana, Ljubljana, Slovenia.
Medical Faculty, University of Ljubljana, Ljubljana, Slovenia.
Clin Transl Radiat Oncol. 2024 Mar 13;46:100764. doi: 10.1016/j.ctro.2024.100764. eCollection 2024 May.
Moderate hypofractionated radiotherapy is the standard of care for all patients with breast cancer, irrespective of stage or prior treatments. While extreme hypofractionation is accepted for early-stage tumours, its application in irradiating locoregional lymph nodes remains controversial.
A prospective registry analysis from July 2020 to September 2023 included 276 patients with early-stage breast cancer treated with one-week ultra-hypofractionation (UHF) at 26 Gy in 5 fractions on the whole breast (58.3 %) or thoracic wall (41.7 %) and ipsilateral regional lymph nodes and simultaneous integrated boost (58.3 %). Primary endpoint was assessment of acute adverse events (AEs). Secondarily, onset of early-delayed toxicity was assessed. A minimum 6-month follow-up was required for assessing potential treatment-related early-delayed complications. Acute or late complications attributable to treatment were assessed at inclusion using the Common Terminology Criteria for Adverse Events (CTCAE) v5.0 criteria.
With a median follow-up of 19 months (range 1-49 months), 159 (57.6 %) patients reported AEs, predominantly grade (G) 1 (n = 139, 50.4 %) and G2 (n = 20, 7.8 %). Skin acute toxicity was common (G1/2: 134, G3: 14), while breast oedema occurred in 10 patients (G1: 9, G2: 1), and 15.9 % reported breast pain (G1: 42, G2: 2). Ipsilateral arm oedema was observed in 1.8 % patients. For patients with a follow-up beyond 6 months (n = 213), 23.4 % patients reported G1/G2 skin AEs, 8.8 % had G1/G2 breast/chest wall oedema, and 8.9 % experienced arm lymphedema. There were no cases of brachial plexopathy or G3 toxicity in this group of patients.
One-week UHF adjuvant locoregional radiation is well-tolerated, displaying low-toxicity profiles comparable to other studies using similar irradiation schedules.
适度低分割放疗是所有乳腺癌患者的标准治疗方案，无论其分期或既往治疗情况如何。虽然早期肿瘤接受大分割放疗已被认可，但其在局部区域淋巴结照射中的应用仍存在争议。
一项前瞻性登记分析纳入了2020年7月至2023年9月期间的276例早期乳腺癌患者，这些患者接受了为期一周的超短程大分割放疗（UHF），全乳（58.3%）或胸壁（41.7%）及同侧区域淋巴结照射剂量为26 Gy，分5次，同时采用同步整合加量放疗（58.3%）。主要终点是评估急性不良事件（AE）。其次，评估早期延迟毒性的发生情况。评估潜在的与治疗相关的早期延迟并发症需要至少6个月的随访。在纳入时使用不良事件通用术语标准（CTCAE）v5.0标准评估治疗引起的急性或晚期并发症。
中位随访时间为19个月（范围1 - 49个月），159例（57.6%）患者报告了AE，主要为1级（n = 139，50.4%）和2级（n = 20，7.8%）。皮肤急性毒性常见（1/2级：134例，3级：14例），10例患者出现乳腺水肿（1级：9例，2级：1例），15.9%的患者报告有乳腺疼痛（1级：42例，2级：2例）。1.8%的患者观察到同侧手臂水肿。对于随访超过6个月的患者（n = 213），23.4%的患者报告有1/2级皮肤AE，8.8%的患者有1/2级乳腺/胸壁水肿，8.9%的患者出现手臂淋巴水肿。该组患者未发生臂丛神经病变或3级毒性病例。
为期一周的UHF辅助局部区域放疗耐受性良好，与其他采用类似照射方案的研究相比，毒性较低。
