Wang Dan-Qiong, Song Yu-Chun, Jing Hao, Fang Hui, Song Yong-Wen, Liu Yue-Ping, Jin Jing, Qi Shu-Nan, Tang Yuan, Lu Ning-Ning, Chen Bo, Li Ning, Zhai Yi-Rui, Zhang Wen-Wen, Liu Xin, Chen Si-Ye, Yang Zhuan-Bo, Sun Guang-Yi, Zhao Xu-Ran, Qiu Zi-Han, Li Ye-Xiong, Tang Yu, Wang Shu-Lian
Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China.
Department of Radiation Oncology, Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, China.
Clin Transl Radiat Oncol. 2025 Apr 25;53:100967. doi: 10.1016/j.ctro.2025.100967. eCollection 2025 Jul.
This study aimed to compare the safety and efficacy of simultaneous integrated boost (SIB) and sequential boost (SeB) during hypofractionated WBI.
This study analyzed data from two prospective studies, including 1,132 patients with pT1-3 N0-3 M0 breast cancer, of whom 775 received SIB and 357 received SeB. The prescribed dose was 43.5 Gy in 15 fractions to whole breast and/or nodal region, with either 49.5 Gy in 15 fractions (SIB) or 8.7 Gy in 3 fractions (SeB) delivered to tumor bed. Outcomes analyzed included survival outcomes, treatment-related toxicities, and cosmetic outcomes.
The 5-year outcomes were local control rates of 97.8 % vs. 98.8 % ( = 0.12), locoregional control rates of 97.7 % vs. 97.1 % ( = 0.72), disease-free survival of 94.1 % vs. 93.1 % ( = 0.71), overall survival of 97.4 % vs. 97.1 % ( = 0.88), and breast-specific survival of 98.2 % vs. 97.5 % ( = 0.43) for SIB versus SeB, respectively. After stabilized inverse probability of treatment weighting, differences between groups remained non-significant. Rates of fair or poor cosmetic outcomes before and after radiotherapy were lower in the SIB group, but there was no difference in cosmetic deterioration (9.8 % vs. 7.6 %, = 0.22). Grade 2 or higher toxicities, including skin toxicity, pneumonitis, breast swelling, pain, induration, lymphedema, and shoulder mobility issues, were comparable between groups.
SIB is a viable alternative to SeB, offering comparable toxicity profiles and survival outcomes while shortening treatment duration. Longer follow-up is warranted to assess long-term outcomes.
本研究旨在比较在大分割全乳照射（WBI）期间同步整合加量（SIB）和序贯加量（SeB）的安全性和疗效。
本研究分析了两项前瞻性研究的数据，包括1132例pT1 - 3 N0 - 3 M0乳腺癌患者，其中775例接受SIB，357例接受SeB。全乳和/或淋巴结区域的处方剂量为15次分割共43.5 Gy，肿瘤床给予15次分割共49.5 Gy（SIB）或3次分割共8.7 Gy（SeB）。分析的结果包括生存结果、治疗相关毒性和美容效果。
SIB组和SeB组的5年局部控制率分别为97.8%对98.8%（P = 0.12），区域控制率分别为97.7%对97.1%（P = 0.72），无病生存率分别为94.1%对93.1%（P = 0.71），总生存率分别为97.4%对97.1%（P = 0.88），乳腺特异性生存率分别为98.2%对97.5%（P = 0.43）。在稳定的治疗权重逆概率分析后，两组之间的差异仍无统计学意义。SIB组放疗前后美容效果为一般或较差的比例较低，但美容效果恶化情况无差异（9.8%对7.6%，P = 0.22）。两组间2级或更高等级的毒性，包括皮肤毒性、肺炎、乳腺肿胀、疼痛、硬结、淋巴水肿和肩部活动问题相当。
SIB是SeB的一种可行替代方案，毒性特征和生存结果相当，但治疗时间缩短。需要更长时间的随访来评估长期结果。
