Reirradiation for Locoregional Recurrent Breast Cancer.
Reirradiation for Locoregional Recurrent Breast Cancer.
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DOI：
10.1016/j.adro.2020.100640
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发表时间：
2021-01
影响因子：
2.3
通讯作者：
Corbin KS
中科院分区：
文献类型：
--
作者：
Fattahi S;Ahmed SK;Park SS;Petersen IA;Shumway DA;Stish BJ;Yan ES;Remmes NB;Mutter RW;Corbin KS
由于与超过正常组织耐受性和可能更具治疗抗性的疾病生物学相关的风险，再照射构成了独特的治疗挑战。我们报告我们的经验，再照射局部复发或第二原发性乳腺癌。在1999年至2019年期间，确定了在我们机构接受重复乳房/胸壁放射治疗（RT）的所有乳腺癌患者。使用不良事件通用术语标准v5.0评估不良事件。采用Fisher精确检验、Mann-Whitney秩和检验和非配对t检验进行统计分析。采用Kaplan-Meier法计算无局部复发和远处转移率以及总生存率。72例患者接受了再照射。中位既往RT剂量、再照射剂量和累积剂量分别为60戈伊（四分位距[IQR]，50-60.4戈伊）、45戈伊（IQR，40-50戈伊）和103.54 Gy 2（IQR，95.04-109.62 Gy 2）。RT疗程之间的中位时间为73个月（IQR，29-129个月）。34例患者（47%）在再照射时有大体残留病变。44名患者（61%）的治疗目的被描述为治愈性，28名患者（39%）为姑息性。52名患者（72%）接受光子±电子治疗，20名（28%）接受质子治疗。中位随访22个月（IQR，10-43个月），13%的患者发生3级不良事件（10%急性皮肤毒性和3%晚期皮肤坏死）。RT疗程和再照射野之间的时间与任何时间点的3级毒性发展显著相关。质子治疗具有剂量学优势，但毒性无差异。2年时，所有患者的局部无复发生存率为74.6%，总生存率为65.5%，而在无肉眼病变的治疗意图患者中，分别为93.1%和76.8%。在所有治愈意向患者中，无远处转移生存率为59.0%。局部复发性乳腺癌的再照射是可行的，毒性率可接受。疾病控制和生存是有希望的治疗意图再照射患者没有严重的疾病。
Reirradiation poses a distinct therapeutic challenge owing to risks associated with exceeding normal tissue tolerances and possibly more therapeutically resistant disease biology. We report our experience with reirradiation for locoregional recurrent or second primary breast cancer. Between 1999 and 2019, all patients with breast cancer treated with repeat breast/chest wall radiation therapy (RT) at our institution were identified. Adverse events were assessed using the Common Terminology Criteria for Adverse Events v5.0. Fisher exact, Mann-Whitney rank-sum, and unpaired t tests were used for statistical analysis. Freedom from locoregional recurrence and distant metastasis as well as overall survival were calculated using the Kaplan-Meier method. Seventy-two patients underwent reirradiation. Median prior RT dose, reirradiation dose, and cumulative dose were 60 Gy (interquartile range [IQR], 50-60.4 Gy), 45 Gy (IQR, 40-50 Gy), and 103.54 Gy2 (IQR, 95.04-109.62 Gy2), respectively. Median time between RT courses was 73 months (IQR, 29-129 months). Thirty-four patients (47%) had gross residual disease at time of reirradiation. Course intent was described as curative in 44 patients (61%) and palliative in 28 (39%). Fifty-two patients (72%) were treated with photons ± electrons and 20 (28%) with protons. With a median follow-up of 22 months (IQR, 10-43 months), grade 3 adverse events were experienced by 13% of patients (10% acute skin toxicity and 3% late skin necrosis). Time between RT courses and reirradiation fields was significantly associated with the development of grade 3 toxicity at any point. Proton therapy conferred a dosimetric advantage without difference in toxicity. At 2 years, locoregional recurrence-free survival was 74.6% and overall survival was 65.5% among all patients, and 93.1% and 76.8%, respectively, among curative intent patients treated without gross disease. Distant metastasis-free survival was 59.0% among all curative intent patients. Reirradiation for locoregional recurrent breast cancer is feasible with acceptable rates of toxicity. Disease control and survival are promising among curative intent reirradiation patients without gross disease.
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DOI：
10.1016/j.ijrobp.2015.01.005
发表时间：
2015-06-01
期刊：
International journal of radiation oncology, biology, physics
影响因子：
--
作者：
Cuaron JJ;Chon B;Tsai H;Goenka A;DeBlois D;Ho A;Powell S;Hug E;Cahlon O
通讯作者：
Cahlon O
影响因子：
5.7
作者：
Linthorst, Marianne;Baaijens, Margreet;van der Zee, Jacoba
通讯作者：
van der Zee, Jacoba
影响因子：
--
作者：
Merino, Tomas;Tran, William T.;Czarnota, Gregory J.
通讯作者：
Czarnota, Gregory J.
影响因子：
5.7
作者：
Oldenborg, Sabine;Griesdoorn, Vanessa;van Tienhoven, Geertjan
通讯作者：
van Tienhoven, Geertjan
影响因子：
6.2
作者：
Hanrahan, EO;Broglio, KR;Rivera, E
通讯作者：
Rivera, E