Leonardi Maria Cristina, Arculeo Simona, Frassoni Samuele, Zerella Maria Alessia, Gerardi Marianna Alessandra, Fodor Cristiana, Veronesi Paolo, Galimberti Viviana Enrica, Magnoni Francesca, Milovanova Ekaterina, Rojas Damaris Patricia, Dicuonzo Samantha, Morra Anna, Zaffaroni Mattia, Vincini Maria Giulia, Cattani Federica, Bagnardi Vincenzo, Orecchia Roberto, Jereczek-Fossa Barbara Alicja
Division of Radiotherapy, European Institute of Oncology, IEO IRCCS, Milan, Italy.
Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy; Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy.
Pract Radiat Oncol. 2025 Jan-Feb;15(1):31-47. doi: 10.1016/j.prro.2024.07.003. Epub 2024 Jul 26.
To evaluate the outcome of partial breast reirradiation (re-PBI) with intensity modulated radiation therapy using a hypofractionated scheme for breast cancer (BC) local relapse (LR) operated on with repeat breast-conservative surgery.
Intensity modulated radiation therapy-based re-PBI was performed using either helical or step-and-shoot modality to deliver 37.05 Gy in 13 fractions in 2.5 weeks. Cumulative incidence of second LR, toxicity, disease-free survival (DFS), BC-specific survival, and overall survival were evaluated.
Between May 2012 and May 2021, 70 patients had re-PBI. The median follow-up (FU) was 6.3 years (quartiles 1-3, 4.0-8.1.). The median age at first LR was 62 years. The median primary BC first LR interval was 12.4 years (range, 1.6-26.7 years). Luminal A-like first LR accounted for 41% of the cases, and the median size was 0.8 cm. During FU, 18 (26%) patients showed a subsequent event: 3 second LRs (corresponding to an 8-year cumulative rate of 4%), 3 regional nodal recurrences, 7 distant metastases, and 5 other primary tumors. At 8 years, DFS, BC-specific survival, and overall survival were 76%, 90%, and 90%, respectively. At multivariate analysis, grade 3 and extensive intraductal components were independent predictors for DFS. For 51 and 46 patients, chronic toxicity and cosmesis were evaluated, respectively: 4% had grade 3 fibrosis, and cosmesis was deemed good/excellent in just >60% of the cases.
Re-PBI after repeat breast-conservative surgery represents a feasible alternative to mastectomy with regard to local control, showing an acceptable toxicity profile. A long-term FU is crucial to better understand the pattern of relapse and consolidate the position of re-PBI in clinical practice.
评估采用大分割方案的调强放射治疗对接受重复保乳手术的乳腺癌（BC）局部复发（LR）进行部分乳腺再照射（re-PBI）的疗效。
基于调强放射治疗的re-PBI采用螺旋或步进-射野模式进行，在2.5周内分13次给予37.05 Gy。评估二次LR的累积发生率、毒性、无病生存期（DFS）、BC特异性生存期和总生存期。
2012年5月至2021年5月期间，70例患者接受了re-PBI。中位随访（FU）时间为6.3年（四分位数1-3，4.0-8.1年）。首次LR时的中位年龄为62岁。原发性BC至首次LR的中位间隔时间为12.4年（范围，1.6-26.7年）。管腔A型首次LR占病例的41%，中位大小为0.8 cm。在随访期间，18例（26%）患者出现后续事件：3例二次LR（对应8年累积发生率为4%）、3例区域淋巴结复发、7例远处转移和5例其他原发性肿瘤。8年时，DFS、BC特异性生存期和总生存期分别为76%、90%和90%。多因素分析显示，3级和广泛的导管内成分是DFS的独立预测因素。分别对51例和46例患者评估了慢性毒性和美容效果：4%的患者有3级纤维化，美容效果在略超过60%的病例中被评为良好/优秀。
重复保乳手术后的re-PBI在局部控制方面是乳房切除术的可行替代方案，毒性表现可接受。长期随访对于更好地了解复发模式和巩固re-PBI在临床实践中的地位至关重要。
