超分割全乳放疗同步整合加量后美容效果恶化的累积风险：最大的真实世界数据

Cumulative Risk of Cosmetic Worsening Following Ultrahypofractionated Whole Breast Radiation Therapy With Simultaneous Integrated Boost: The Largest Real-World Data.

作者信息

Wadasadawala Tabassum, Syeda Naseera, Kenekar Shraddha, Krishnamurthy Revathy, Sarin Rajiv, Pathak Rima, Rane Pallavi, Pawar Akash, Upadhyay Prachi, Joshi Shalaka, Parmar Vani, Nair Nita, Shejwal Manisha, Chavan Sonal

机构信息

Breast Cancer Disease Management Group, Department of Radiation Oncology, Tata Memorial Centre, Mumbai, India.

出版信息

Int J Radiat Oncol Biol Phys. 2025 May 29. doi: 10.1016/j.ijrobp.2025.05.061.

DOI:10.1016/j.ijrobp.2025.05.061

PMID:40449565

Abstract

PURPOSE

Randomized trials have shown that ultrahypofractionated radiation therapy (uHFRT) is a safe alternative to moderately hypofractionated or conventional breast radiation therapy. However, its safety in patients requiring a tumor bed boost cannot be firmly established, as none of the patients in the FAST trial and only a quarter of the patients in the FAST-FORWARD trial were offered a tumor bed boost. We aimed to report the real-world experience of cosmetic outcomes after whole breast irradiation with uHFRT and a simultaneous integrated boost (SIB).

METHODS AND MATERIALS

The study population consisted of 354 breast cancer patients treated with uHFRT from 2020 to 2022. All patients received SIB either with electrons (n = 207) or photons (n = 147). The SIB dose was 33 Gy and 32 Gy for the FAST (n = 74) and FAST-FORWARD (n = 280) protocols, respectively. Cosmesis was assessed subjectively by the physicians and the patients and objectively by the BCCT.core software. The worsening of breast cosmesis was defined as a shift in the score from any lower to a higher category on a 4-point scale, ie, excellent (0), good (1), fair (3), and poor (4).

RESULTS

The median follow-up time of the cohort was 31.31 months. As per the physicians' ratings, cosmetic deterioration at 1 year was 17% (13%, 21%), which doubled to 34% (29%, 39%) at 2 years. Patient-rated worsening was 9% (6.3%, 12%) at 1 year and 15% (12%, 19%) at 2 years. Similarly, the BCCT.core rating also showed temporal worsening: 17% (13%, 22%) at 1 year and 33% (28%, 38%) at 2 years. Multivariate analysis showed that higher body mass index, postmenopausal status, women with larger breast volumes, oncoplastic surgery, regional nodal irradiation, and the FAST-FORWARD protocol were factors associated with a higher risk of cosmetic worsening.

CONCLUSIONS

We observed that uHFRT with SIB was associated with an early cosmetic deterioration that progressively worsened over time. These real-world findings offer valuable insights to support informed clinical decision-making.

摘要

目的

随机试验表明，超高分割放疗（uHFRT）是中等分割或传统乳腺放疗的一种安全替代方案。然而，对于需要瘤床加量的患者，其安全性尚未得到确切证实，因为FAST试验中的患者均未接受瘤床加量，而FAST-FORWARD试验中只有四分之一的患者接受了瘤床加量。我们旨在报告采用uHFRT和同步整合加量（SIB）进行全乳照射后美容效果的真实世界经验。

方法和材料

研究人群包括2020年至2022年期间接受uHFRT治疗的354例乳腺癌患者。所有患者均接受了电子线（n = 207）或光子线（n = 147）的SIB。对于FAST方案（n = 74）和FAST-FORWARD方案（n = 280），SIB剂量分别为33 Gy和32 Gy。由医生和患者对美容效果进行主观评估，并通过BCCT.core软件进行客观评估。乳腺美容效果变差定义为在4分制量表上评分从较低类别转变为较高类别，即优（0）、良（1）、中（3）和差（4）。

结果

该队列的中位随访时间为31.31个月。根据医生的评分，1年时美容效果变差的比例为17%（13%，21%），2年时增至34%（29%，39%）。患者自评的变差比例在1年时为9%（6.3%，12%），2年时为15%（12%，19%）。同样，BCCT.core评分也显示出随时间变差：1年时为17%（13%，22%），2年时为33%（28%，38%）。多因素分析表明，较高的体重指数、绝经后状态、乳房体积较大的女性、肿瘤整形手术、区域淋巴结照射以及FAST-FORWARD方案是与美容效果变差风险较高相关的因素。