Symptoms Related to Brachial Plexus Neuropathy After Supraclavicular Irradiation and Boost in Breast Cancer
Symptoms Related to Brachial Plexus Neuropathy After Supraclavicular Irradiation and Boost in Breast Cancer
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乳腺癌锁骨上照射和增强后臂丛神经病变的相关症状
DOI：
10.1016/j.prro.2021.08.003
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发表时间：
2022-01-03
影响因子：
3.3
通讯作者：
Yu, Xiaoli
中科院分区：
文献类型：
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作者：
Jin, Kairui;Luo, Jurui;Yu, Xiaoli
目的：探讨乳腺癌患者接受锁骨上照射后，臂丛神经病变(BPN)相关症状的发生率及其对臂丛神经的剂量分布情况。方法与材料：回顾分析2008~2018年间我科肿瘤中心收治的117例初发同侧锁骨上淋巴结(SLN)转移患者和39例复发SLN患者的临床资料。所有患者均接受50Gy25次SCV照射，并对SCV区受累结节进行放疗(中位剂量10Gy10~16Gy.)。记录与BPN相关的症状(包括同侧手臂麻木、疼痛和虚弱)，并根据不良事件通用术语标准5.0版进行分级。在模拟CT上勾画出BP，并评估BP的剂量分布。同时，以297例同期接受SCV照射的患者为对照组，比较两组患者BPN相关症状和剂量学指标的发生率。结果：初发SLN转移患者的5年总生存率为80.3%，复发SLN转移患者的5年总生存率为51.0%。在接受SCV增强的患者中，同侧手臂麻木、疼痛和虚弱的发生率分别为23.9%、18.3%和34.3%。4例(5.6%)出现2级麻木，3例(4.3%)出现2级手臂无力。对照组上肢麻木、疼痛、无力的发生率分别为31.6%、21.9%、36.0%。两组患者BPN相关症状发生率差异无统计学意义。在两个队列中都没有观察到3级症状。接受和未接受增压治疗的患者血压平均剂量分别为56.8和46.8Gy(P<；.001)。接受和未接受增压治疗的患者血压最大剂量分别为64.5和53.5Gy(P<；.001)。接受至少50、60、61和62Gy四种剂量照射的BPN患者的血压也明显高于对照组(P&t；.001)。结论：SCV值每增加10GyBPN相关症状的发生率不增加，BP的毒性是可以接受的。包括SCV照射和增强在内的综合治疗使有SLN转移的乳腺癌患者获得了满意的生存结果。(C)2021年美国放射肿瘤学学会。爱思唯尔公司出版，版权所有。
Purpose: To evaluate the incidence of symptoms related to brachial plexus neuropathy (BPN) and the dose distribution to the brachial plexus (BP) in patients with breast cancertreated with supraclavicular (SCV) irradiation and boost.Methods and Materials: In this study, 117 patients with initial ipsilateral supraclavicular lymph node (SLN) metastasis and 39 with recurrent SLN metastasis between 2008 and 2018 in our cancer center were retrospectively analyzed. All patients were treated with 50 Gy of SCV irradiation in 25 fractions anda boost (median dose, 10 Gy; range, 10-16 Gy) to involved nodes in the SCV area. Symptoms related to BPN (including ipsilateral arm numbness, pain, and weakness) were recorded and graded according to the Common Terminology Criteria for Adverse Events, version 5.0. The BP was delineated on simulation computed tomography, and the dose distribu-tions to the BP were evaluated. Meanwhile, 297 patients treated with SCV irradiation without boost during the same period were identified as a control group to compare the incidences of BPN-related symptoms and dosimetric data with patients who received an SCV boost.Results: The 5-year overall survival rate was 80.3% for patients with initial SLN metastasis and 51.0% for patients with recurrent SLN metastasis. For patients who received an SCV boost, incidence rates of ipsilateral arm numbness, pain, and weakness were 23.9%, 18.3%, and 34.3%, respectively. Four patients (5.6%) developed grade 2 numbness and 3 (4.3%) developed grade 2 arm weakness. In the control group, incidence rates of arm numbness, pain, and weakness were 31.6%, 21.9%, and 36.0%, respectively. The incidence of BPN-related symptoms was not significantly different between the 2 groups. Symptoms of grade 3 were not observed in either cohort. The mean doses to the BP in patients who received boost and who did not were 56.8 and 46.8 Gy, respectively (P < .001). The maximum doses to the BP in patients who received boost and who did not were 64.5 and 53.5 Gy, respectively (P < .001). The BP vol-umes receiving at least 50 Gy, 60 Gy, 61 Gy, and 62 Gy were also significantly higher in the boosted group compared with the control group (P < .001).Conclusions: This study found that an SCV boost of 10 Gy did not increase the incidence of BPN-related symptoms and that the toxicity to the BP was acceptable. Comprehensive treatment including SCV irradiation and boost led to satisfactory survival outcomes in patients with breast cancer who had SLN metastasis. (C) 2021 American Society for Radiation Oncology. Published by Elsevier Inc. All rights reserved.