早期乳腺癌保乳术后三维适形加速部分乳腺照射的疗效

目的 分析早期低危乳腺癌保乳术后三维适形加速部分乳腺照射(APBI)的局部控制情况、美容评价及不良反应,并对剂量学结果进行质量评估。方法 2008—2010年前瞻性临床Ⅱ期研究入组 39例早期(0~Ⅰ期)乳腺癌保乳术后患者,其中浸润性导管癌 28例、导管原位癌 5例、其他类型浸润性癌 6例。放疗处方剂量为38.5 Gy分10次,2 次/d,间隔6 h以上。不良反应评价采用NCI-CTC 3.0标准,美容评价依据Harris美容级别标准。结果 三维适形APBI技术应用于早期乳腺癌保乳术后获得了满意的剂量学结果,85%(33例)患者完全满足放疗质量控制评估标准。与ASTRO、GEC-ESTRO共识比较中危/高危患者比例分别为46%、18%和31%、3%。随访率100%,无一局部复发,无3、4级不良反应。放疗后6个月美容评价优异加良好者占90%(35例)。结论 三维适形APBI入组患者选择恰当,局部控制、不良反应和美容评价初步结果较好。

Clinical effects of accelerated partial breast irradiation using three-dimensional conformal radiotherapy in patients with early breast cancer after breast-conserving therapy

Objective To assess the clinical effects of accelerated partial breast irradiation (APBI) using three-dimensional conformal radiotherapy (3DCRT) in patients with low-risk early breast cancer after breast-conserving therapy (BCT) with respect to dosimetric parameters, local control, toxicities, and cosmetic outcome. Methods Thirty-nine patients with early breast cancer (stage 0—1) were enrolled in a prospective phase Ⅱ trial of APBI using 3DCRT in 2008—2010. Of all the patients, 28 had invasive ductal carcinoma, 5 had ductal carcinoma in situ, and 6 had other types of invasive carcinoma. The prescribed dose was 38.5 Gy/10 fractions twice daily, with an inter-fraction interval greater than 6 h. The toxicities were assessed according to the National Cancer Institute Common Toxicity Criteria, version 3.0. The cosmetic outcome was assessed according to the Harris breast cosmesis scale. Results The planning target volume coverage and normal-tissue dosimetry were appropriate in the APBI using 3DCRT. Dose homogeneity without deviation was achieved in 33 patients (85%). Of the total 39 patients, 46% met ASTRO′s "cautionary" criteria, and 18% met"unsuitable" criteria;also, 31% met GEC-ESTRO′s"intermediate-risk" criteria, and 3% met"high-risk" criteria. The follow-up rate was 100%. No patient experienced local recurrence, and no grade 3—4 toxicities were found. Cosmesis was good to excellent in 35 patients (90%) at 6 months after APBI. Conclusions The patients with early breast cancer after BCT are properly selected for APBI using 3DCRT, with satisfactory preliminary assessment results for local control, toxicities, and cosmetic outcome.