Intensity modulated radiation therapy (IMRT) decreases acute skin toxicity for women receiving radiation for breast cancer
Intensity modulated radiation therapy (IMRT) decreases acute skin toxicity for women receiving radiation for breast cancer
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DOI：
10.1097/01.coc.0000197661.09628.03
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发表时间：
2006-02-01
影响因子：
2.6
通讯作者：
Nicolaou, N
中科院分区：
文献类型：
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作者：
Freedman, GM;Anderson, PR;Nicolaou, N
目的：确定胸部调强放射治疗(IMRT)患者急性皮肤毒性的临床观察发生率和严重程度，并将结果与常规放射治疗的匹配队列患者进行比较。我们的假设是，采取措施减少调强放疗中乳房和皮肤内剂量的不均一性将改善急性皮肤毒性。材料和方法：研究人群包括73名接受保乳手术和调强放疗的早期乳腺癌患者。调强放射治疗技术包括用于优化以生成调强放射治疗计划的迭代方法、蒙特卡罗剂量计算，以及使用多叶准直进行射束传输的分步拍摄技术。该技术的其他方面，包括医生对临床靶区体积的临床定义、患者位置、切向射束方向、剂量和野大小与传统的切向照射相比没有变化。这些患者被一对一地与60名接受常规光子辐射的对照组进行匹配，方法是根据她们的胸围大小和胸壁分离进行治疗。研究的终点是急性皮肤毒性。结果：根据急性放射性皮炎不良事件(CTC)的通用术语标准，急性毒性没有观察到差异。42%的患者无脱屑，37%的患者出现干性脱屑，21%的患者出现湿性脱屑。常规放疗组脱屑程度较调强放疗组大，分别为0级52%、1级10%、2级38%(P=0.001)。亚组分析显示，小乳房(P=0.038)和大乳房(P=0.037)的脱皮发生率显著低于中等乳房(P=0.454)。对于大乳房，调强放射治疗组2级湿性脱屑的发生率为48%，而对照组为79%。在逐步Logistic回归分析中，湿性脱皮的显著预测因素是调强放疗的使用(P=0.0011)和乳房大小(P<；0.0001)。结论：与接受常规放射治疗的对照组相比，调强放疗与急性脱皮的严重程度降低有关。与常规放射一样，乳房大小仍然是急性皮肤毒性最重要的预后因素。急性放射性皮炎的CTC分级系统在应用于现代乳腺癌治疗时并不敏感，因为它依赖于红斑的主观分级，并且无法测量脱皮的变化。需要对患者症状、生活质量和美容进行进一步研究，以评估调强放射治疗对乳腺癌的益处。
Objective: To determine the clinically observed incidence and severity of acute skin toxicity with breast intensity modulated radiation therapy (IMRT), and compare the results with a matched cohort of patients treated by conventional radiation therapy. Our hypothesis is that measures to decrease dose inhomogeneity within the breast and skin with IMRT will improve acute skin toxicity.Materials and Methods: The study population consists of 73 women with early stage breast cancer treated with breast-conserving surgery and IMRT. The IMRT technique involves an iteration method for optimization to generate the IMRT plan, Monte Carlo dose calculation, and a step-and-shoot technique using multileaf collimation for beam delivery. Other aspects of the technique including the clinical definition of the clinical target volume by the physician, patient positioning, tangential beam orientation, dose and field sizes were unchanged compared conventional tangential radiation. These patients were matched one-to-one to a control group of 60 women treated with conventional photon radiation by using their bra size and chest wall separation. The study end point was acute skin toxicity.Results: There were no observed differences in the acute toxicity based upon common terminology criteria for adverse events (CTC) for acute radiation dermatitis. There was no desquamation in 42% of IMRT patients, dry desquamation in 37% and moist desquamation in 21%. The degree of desquamation was greater for conventional patients compared with IMRT patients -52% grade 0, 10% grade 1, and 38% grade 2 (P = 0.001). Subgroup analysis showed desquamation was significantly lower with IMRT for small (P = 0.038) and large breast sizes (P = 0.037), but not medium sizes (P = 0.454). For large breast sizes, the incidence of moist desquamation grade 2 was 48% with IMRT compared with 79% in controls. Significant predictors of moist desquamation on stepwise logistic regression were use of IMRT (P = 0.0011) and breast size (P < 0.0001).Conclusions: IMRT is associated with a decrease in severity of acute desquamation compared with a matched control group treated with conventional radiation therapy. As with conventional radiation, breast size remains the most important prognostic factor for acute skin toxicity. The CTC grading system for acute radiation dermatitis is not sensitive when applied to modem breast cancer treatment because of its dependence of subjective rating of erythema and inability to gauge variations in desquamation. Further study of patient symptoms, quality of life, and cosmesis is needed to evaluate the benefit of IMRT for breast cancer.