- 作者：Benjamin D. Smith M.D.* ; bsmith3@mdanderson.org"" rel=""nofollow ; Soren M. Bentzen Ph.D. ; D.Sc.† ; ; Candace R. Correa M.D.‡ ; ; Carol A. Hahn M.D.§ ; ; Patricia H. Hardenbergh M.D.¶ ; ; Geoffrey S. Ibbott Ph.D. ; Beryl McCormick M.D. ; FACR.# ; Julie R. McQueen CHES. ; RHEd.** ; Lori J. Pierce M.D.† ; † ; ; Simon N. Powell M.D. ; Ph.D.# ; Abram Recht M.D.§ ; § ; ; Alphonse G. Taghian M.D. ; Ph.D.¶ ; ¶ ; ; Frank A. Vicini M.D. ; FACR. ; Julia R. White M.D.## ; Bruce G. Haffty M.D.***
- 刊名：International Journal of Radiation Oncology*Biology*Physics
- 出版年：2011
- 出版时间：1 September 2011
- 年：2011
- 卷：81
- 期：1
- 页码：59-68
- 全文大小：136 K
Purpose
In patients with early-stage breast cancer treated with breast-conserving surgery, randomized trials have found little difference in local control and survival outcomes between patients treated with conventionally fractionated (CF-) whole breast irradiation (WBI) and those receiving hypofractionated (HF)-WBI. However, it remains controversial whether these results apply to all subgroups of patients. We therefore developed an evidence-based guideline to provide direction for clinical practice.Methods and Materials
A task force authorized by the American Society for Radiation Oncology weighed evidence from a systematic literature review and produced the recommendations contained herein.
Results
The majority of patients in randomized trials were aged 50 years or older, had disease Stage pT1-2 pN0, did not receive chemotherapy, and were treated with a radiation dose homogeneity within ±7 % in the central axis plane. Such patients experienced equivalent outcomes with either HF-WBI or CF-WBI. Patients not meeting these criteria were relatively underrepresented, and few of the trials reported subgroup analyses. For patients not receiving a radiation boost, the task force favored a dose schedule of 42.5 Gy in 16 fractions when HF-WBI is planned. The task force also recommended that the heart should be excluded from the primary treatment fields (when HF-WBI is used) due to lingering uncertainty regarding late effects of HF-WBI on cardiac function. The task force could not agree on the appropriateness of a tumor bed boost in patients treated with HF-WBI.
Conclusion
Data were sufficient to support the use of HF-WBI for patients with early-stage breast cancer who met all the aforementioned criteria. For other patients, the task force could not reach agreement either for or against the use of HF-WBI, which nevertheless should not be interpreted as a contraindication to its use.