Feasibility and Acute Toxicity of Hypofractionated Radiation in Large-breasted Patients
Feasibility and Acute Toxicity of Hypofractionated Radiation in Large-breasted Patients
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DOI：
10.1016/j.ijrobp.2011.05.074
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发表时间：
2012-05-01
影响因子：
7
通讯作者：
Chmura, Steven J.
中科院分区：
文献类型：
--
作者：
Dorn, Paige L.;Corbin, Kimberly S.;Chmura, Steven J.
目的：为了确定的可行性和急性毒性与hypofractionated全乳房放疗（hypRT）后，乳腺癌保乳手术的患者排除或代表性不足的随机试验比较hypRT与常规fractionationschedures.Methods和材料：进行了审查，所有患者连续治疗hypRT在芝加哥大学。所有患者在俯卧位或仰卧位接受42.56戈伊治疗，每日分次2.66戈伊。在大多数情况下，使用楔形和大段或“场中”技术进行规划。使用计划靶体积（PTV）的体积测量来估计乳房体积。记录每个治疗计划的异质性剂量学参数（V105、V107、V110和最大剂量）。急性毒性评分为每个治疗breast.Results：在2006年和2010年之间，78例患者进行了治疗，80乳房使用低放射治疗。大多数女性超重或肥胖（78.7%），体重指数中位数为29.2 kg/m（2）。中位乳房体积为1，351 mL。在80个治疗乳房中，最大的急性皮肤毒性为轻度红斑或色素沉着，占70.0%（56/80），干性脱屑占21.25%（17/80），局灶性湿性脱屑占8.75%（7/80）。31.9%的患者在放疗结束后出现最大急性毒性。间隔>25 cm与毒性增加无关。多变量分析中，乳房体积是唯一与湿性脱皮显著相关的患者因素（p = 0.01）。当采用现代计划和定位技术时，乳房体积> 2，500 mL的患者中有27.2%的病例发生局灶性湿性脱屑，而乳房体积25 cm的患者和乳房体积较大的患者中有6.34%的病例发生局灶性湿性脱屑。我们建议咨询PTV体积>2,500 mL的女性皮肤毒性的预期增加。(C)2012 Elsevier Inc.
Purpose: To determine the feasibility of and acute toxicity associated with hypofractionated whole breast radiation (HypoRT) after breast-conserving surgery in patients excluded from or underrepresented in randomized trials comparing HypoRT with conventional fractionation schedules.Methods and Materials: A review was conducted of all patients consecutively treated with HypoRT at the University of Chicago. All patients were treated to 42.56 Gy in 2.66 Gy daily fractions in either the prone or supine position. Planning was performed in most cases using wedges and large segments or a "field-in-field" technique. Breast volume was estimated using volumetric measurements of the planning target volume (PTV). Dosimetric parameters of heterogeneity (V105, V107, V110, and maximum dose) were recorded for each treatment plan. Acute toxicity was scored for each treated breast.Results: Between 2006 and 2010, 78 patients were treated to 80 breasts using HypoRT. Most women were overweight or obese (78.7%), with a median body mass index of 29.2 kg/m(2). Median breast volume was 1,351 mL. Of the 80 treated breasts, the maximum acute skin toxicity was mild erythema or hyperpigmentation in 70.0% (56/80), dry desquamation in 21.25% (17/80), and focal moist desquamation in 8.75% (7/80). Maximum acute toxicity occurred after the completion of radiation in 31.9% of patients. Separation >25 cm was not associated with increased toxicity. Breast volume was the only patient factor significantly associated with moist desquamation on multivariable analysis (p = 0.01). Patients with breast volume >2,500 mL experienced focal moist desquamation in 27.2% of cases compared with 6.34% in patients with breast volume 25 cm and in patients with large breast volume when employing modern planning and positioning techniques. We recommend counseling regarding expected increases in skin toxicity in women with a PTV volume >2,500 mL. (C) 2012 Elsevier Inc.