定义最佳剂量为3维符合加速部分乳房辐射:15年后期的剂量升级试验
Alphonse G Taghian1, George E Naoum2, Lior Z Braunstein3
1Radiation Oncology Department, Harvard Medical School, Boston, Massachusetts; Radiation Oncology Department, Massachusetts General Hospital, Boston, Massachusetts.
International journal of radiation oncology, biology, physics
|January 11, 2025
概括
对于加速部分乳房照射 (APBI),32 Gy,36 Gy和40 Gy显示出类似的局部瘤控制. 高剂量的APBI增加了纤维化和恶化的化品结果,这表明32 Gy是最佳的.
科学领域:
- 在瘤学瘤学.
- 辐射瘤学 辐射瘤学
- 乳腺癌治疗方法 乳腺癌治疗方法
背景情况:
- 加快部分乳房照射 (APBI) 是全乳房照射的替代方案.
- 对于瘤控制和毒性来说,最佳的APBI剂量尚未确立.
研究的目的:
- 在早期乳腺癌患者中评估升级剂量APBI的疗效和毒性.
- 确定APBI的最佳剂量,以最大限度地控制瘤并最大限度地减少不良影响.
主要方法:
- 一个连续剂量升级试验,涉及324名在位管道癌或I期侵袭性乳腺癌患者.
- 外部光束APBI每天两次以4Gy分数输送,总剂量为32Gy,36Gy和40Gy.
- 对局部衰竭,纤维化和化品结果的随访.
主要成果:
- 在32 Gy,36 Gy和40 Gy剂量队列中的15年局部失效率没有显著差异 (P = .21).
- 10年中度/重度纤维化发生率随着剂量增加而显著增加 (40%对58%对67%,P<.01).
- 10年化品结局 (患者和医生评估) 在较高的APBI剂量 (P < .01) 时明显恶化.
结论:
- 经过测试的APBI分成方案没有证明在超过32 Gy的剂量中,局部失效率有好处.
- 较高的APBI剂量 (36 Gy和40 Gy) 与纤维化率的增加和更差的化品效果有关.
- 在这种分成方案中,32 Gy似乎是最佳剂量,平衡有效性和毒性.
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