- 作者：Lorenzo Livi ; Icro Meattini ; Davide Franceschini ; Calogero Saieva ; Fiammetta Meacci ; Livia Marrazzo ; Elena Gerlain ; Isacco Desideri ; Vieri Scotti ; Jacopo Nori ; Luis Jose Sanchez ; Lorenzo Orzalesi ; Pierluigi Bonomo ; Daniela Greto ; Simonetta Bianchi ; Giampaolo Biti
- 关键词：Invasive breast cancer ; Breast-conserving surgery ; Tumor margins ; Radiotherapy boost ; Dose escalation
- 刊名：Radiotherapy and Oncology
- 出版年：2013
- 出版时间：August, 2013
- 年：2013
- 卷：108
- 期：2
- 页码：273-278
- 全文大小：248 K
Purpose
To investigate the outcome of invasive early breast cancer patients that underwent breast-conserving surgery and adjuvant radiotherapy (RT), treated with a prospective margin-directed institutional policy for RT boost dose, based on final margins status (FMS).Methods and materials
A total of 2093 patients were treated between 2000 and 2008. 10 Gy boost was prescribed in case of FMS > 5 mm; 16 Gy boost with FMS between 2 and 5 mm; 20 Gy boost in case of FMS < 2 mm or positive.
Results
After a median follow up of 5.2 years, we recorded 41 local relapse (LR, 2 % ). Concerning LR free survival, age at diagnosis, nuclear grade, hormonal status, T-stage, adjuvant hormonal therapy and adjuvant chemotherapy emerged as significant parameters (p-values from log rank test <0.05). FMS, that directed the RT boost dose, did not have significant impact on LRFS (p = 0.46). LR rates were 2.3 % for FMS < 2 mm, 2.6 % for 2-5 mm FMS and 1.8 % for FMS > 5 mm. At multivariate analysis, higher nuclear grade (p = 0.045), triple negative subtype (p = 0.036) and higher T-stage (p = 0.02) resulted as the independent predictors of LR occurrence.
Conclusions
Our experience showed that a margin-directed policy of RT boost dose-escalation seems to reduce the negative impact of FMS on LR, but it is not able to overcome the unfavorable effect of higher nuclear grade, higher T stage and triple negative subtype.