Prone whole-breast irradiation using three-dimensional conformal radiotherapy in women undergoing breast conservation for early disease yields high rates of excellent to good cosmetic outcomes in patients with large and/or pendulous breasts.
Prone whole-breast irradiation using three-dimensional conformal radiotherapy in women undergoing breast conservation for early disease yields high rates of excellent to good cosmetic outcomes in patients with large and/or pendulous breasts.
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DOI：
10.1016/j.ijrobp.2011.08.020
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发表时间：
2012-07-01
影响因子：
7
通讯作者：
White, Julia
中科院分区：
文献类型：
--
作者：
Bergom, Carmen;Kelly, Tracy;Morrow, Natalya;Wilson, J. Frank;Walker, Alonzo;Xiang, Qun;Ahn, Kwang Woo;White, Julia
报告我们机构在乳房较大和/或下垂的女性队列中使用俯卧位进行三维适形放疗（3D-CRT）以提供乳房肿瘤切除术后全乳照射（WBI）的经验，以确定急性和晚期毒性的发生率，更具体地说，是美容结局。我们假设在俯卧位使用3D-CRT进行WBI将减少或消除患者和乳房大小作为WBI相关毒性的负面预后指标。自1998年至2006年，110例患者采用3D-CRT进行俯卧位WBI治疗。在所有计算机断层扫描上勾画肿块切除术、乳腺靶体积、心脏和肺的轮廓。使用标准分割方案，对乳房体积规定45-50戈伊的剂量。计划目标为≥95%处方剂量至95%乳房体积，100%加强剂量至95%肿块切除计划靶体积。使用不良反应通用术语标准3.0版和哈佛量表对毒性和美观进行前瞻性评分。中位随访时间为40个月。中位体重指数（BMI）为33.6 kg/m2，中位乳房体积为1396 cm 3。在放射治疗期间遇到的最严重的毒性是3级皮炎，占我们患者人群的5%。16%的患者发生湿性脱屑，只有2%的患者在乳房下/腋窝皱襞外发生湿性脱屑。11%的患者发生≥2级晚期毒性，包括2%的3级硬结/纤维化。89%的患者达到了极好的美容效果。较高的BMI与潮湿脱皮和乳房疼痛相关，但BMI和乳房体积并不影响纤维化或极好的美容效果。在BMI较高和/或乳房下垂较大的患者中，使用3D-CRT输送俯卧位WBI可产生有利的毒性特征和较高的从优到良的美容率。较高的BMI与潮湿脱皮相关，但俯卧位排除了BMI和乳房大小作为较差美容结局的因素。这一系列增加了越来越多的文献表明，倾向WBI可能是有利的选择患者。
To report our institution’s experience using prone positioning for three-dimensional conformal radiotherapy (3D-CRT) to deliver post-lumpectomy whole breast irradiation (WBI) in a cohort of women with large and/or pendulous breasts, to determine the rate of acute and late toxicities and, more specifically, cosmetic outcomes. We hypothesized that using 3D-CRT for WBI in the prone position would reduce or eliminate patient and breast size as negative prognostic indicators for toxicities associated with WBI. From 1998 to 2006, 110 cases were treated with prone WBI using 3D-CRT. The lumpectomy, breast target volumes, heart, and lung were contoured on all computed tomography scans. A dose of 45–50 Gy was prescribed to the breast volume using standard fractionation schemes. The planning goals were ≥95% of prescription to 95% of the breast volume, and 100% of boost dose to 95% of lumpectomy planning target volume. Toxicities and cosmesis were prospectively scored using the Common Terminology Criteria for Adverse Effects Version 3.0 and the Harvard Scale. The median follow-up was 40 months. The median body mass index (BMI) was 33.6 kg/m2, and median breast volume was 1396 cm3. The worst toxicity encountered during radiation was Grade 3 dermatitis in 5% of our patient population. Moist desquamation occurred in 16% of patients, with only 2% of patients with moist desquamation outside the inframammary/axillary folds. Eleven percent of patients had Grade ≥2 late toxicities, including Grade 3 induration/fibrosis in 2%. Excellent to good cosmesis was achieved in 89%. Higher BMI was associated with moist desquamation and breast pain, but BMI and breast volume did not impact fibrosis or excellent to good cosmesis. In patients with higher BMI and/or large–pendulous breasts, delivering prone WBI using 3D-CRT results in favorable toxicity profiles and high excellent to good cosmesis rates. Higher BMI was associated with moist desquamation, but prone positioning removed BMI and breast size as factors for poorer cosmetic outcomes. This series adds to the growing literature demonstrating that prone WBI may be advantageous in select patients.
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DOI：
10.1016/s0360-3016(97)00292-7
发表时间：
1997-08-01
影响因子：
7
作者：
Buchholz, TA;Gurgoze, E;Prestidge, BR
通讯作者：
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DOI：
10.1097/01.coc.0000197661.09628.03
发表时间：
2006-02-01
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发表时间：
1983-01-01
影响因子：
7
作者：
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DOI：
10.1016/j.ijrobp.2004.04.036
发表时间：
2004-10-01
影响因子：
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