Hypofractionation with simultaneous integrated boost for early breast cancer

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• 作者：Kathrin Dellas MD (1) (2)
  Dr. Reinhard Vonthein (3) (4)
  J?rg Zimmer MD (5)
  Stefan Dinges MD (6)
  Alexander D. Boicev MD (7)
  Peter Andreas MD (8)
  Dorothea Fischer MD (9)
  Cornelia Winkler MD (10)
  Prof. Dr. Andreas Ziegler (3) (4)
  Prof. Jürgen Dunst MD (1) (11) (2)
  ARO Study Group
  
• 关键词：Breast cancer ; Hypofractionation ; Simultaneous integrated boost ; Feasibility ; Toxicity ; Mammakarzinom ; Hypofraktionierung ; Simultan ; integrierter Boost ; Durchführbarkeit ; Toxizit?t
• 刊名：Strahlentherapie und Onkologie
• 出版年：2014
• 出版时间：June 2014
• 年：2014
• 卷：190
• 期：7
• 页码：646-653
• 全文大小：
• 参考文献：1. Clarke M, Collins R, Darby S et al, Early Breast Cancer Trialists-Collaborative Group (EBCTCG) (2005) Effects of radiotherapy and of differences in the extent of surgery for early breast cancer on local recurrence and 15-year survival: an overview of the randomised trials. Lancet 366:2087-106 CrossRef
  2. Darby S, McGale P, Correa C et al (2011) Effect of radiotherapy after breast-conserving surgery on 10-year recurrence and 15-year breast cancer death: meta-analysis of individual patient data for 10,801 women in 17 randomised trials. Lancet 378:1707-716 CrossRef
  3. Whelan TJ, Julian J, Wright J et al (2000) Does locoregional RT improve survival in breast cancer? A meta-analysis. J Clin Oncol 18:1220-229
  4. Bartelink H, Horiot JC, Poortmans P et al (2007) Impact of a higher radiation dose on local control and survival in breast-conserving therapy of early breast cancer: 10-year results of the randomized boost versus no boost EORTC 22881-10882 trial. J Clin Oncol 22:3259-326 CrossRef
  5. Livi L, Borghesi S, Saieva C et al (2009) Benefit of radiation boost after whole-breast radiotherapy. Int J Radiat Oncol Biol Phys 75:1029-034 CrossRef
  6. Azria D, Auvray H, Barillot I et al (2008) Ductal carcinoma in situ: role of the boost. Cancer Radiother 12:571-76 CrossRef
  7. Whelan TJ, Pignol JP, Levine MN et al (2010) Long-term results of hypofractionated radiation therapy for breast cancer. N Engl J Med 362:513-20 CrossRef
  8. START Trialists-Group, Bentzen SM, Agrawal RK, Aird EG et al (2008) The UK Standardization of Breast Radiotherapy (START) Trial A of radiotherapy hypofractionation for treatment of early breast cancer: a randomised trial. Lancet Oncol 9:331-41 CrossRef
  9. START Trialists-Group, Bentzen SM, Agrawal RK, Aird EG et al (2008) The UK Standardization of Breast Radiotherapy (START) Trial B of radiotherapy hypofractionation for treatment of early breast cancer: a randomised trial. Lancet 371:1098-107 CrossRef
  10. Owen JR, Ashton A, Bliss JM et al (2006) Effect of radiotherapy fraction size on tumour control in patients with early-stage breast cancer after local tumour excision: long-term results of a randomized trial. Lancet Oncol 7:467-71 CrossRef
  11. Sedlmayer F, Sautter-Bihl ML, Budach W et al (2013) Breast Cancer Expert Panel of the German Society of Radiation Oncology (DEGRO). Is the simultaneously integrated boost (SIB) technique for early breast cancer ready to be adopted for routine adjuvant radiotherapy? Statement of the German and the Austrian Societies of Radiooncology (DEGRO/?GRO). Strahlenther Onkol 189:193-96 CrossRef
  12. Sedlmayer F, Sautter-Bihl ML, Budach W et al (2013) Breast Cancer Expert Panel of the German Society of Radiation Oncology (DEGRO). DEGRO practical guidelines: radiotherapy of breast cancer I. Radiotherapy following breast conserving therapy for invasive breast cancer. Strahlenther Onkol 189:825-33 CrossRef
  13. Chadha M, Vongtama D, Friedmann P et al (2012) Comparative acute toxicity from whole breast irradiation using 3-week accelerated schedule with concomitant boost and the 6.5-week conventional schedule with sequential boost for early-stage breast cancer. Clin Breast Cancer 12:57-2 CrossRef
  14. Van Parijs HM, Vinh-Hung V et al (2012) Short course radiotherapy with simultaneous integrated boost for stage I–II breast cancer, early toxicities of a randomized clinical trial. Radiat Oncol 7:80 CrossRef
  15. Scorsetti M, Alongi F, Fogliata A et al (2012) Phase I–II study of hypofractionated simultaneous integrated boost using volumetric modulated arc therapy for adjuvant radiation therapy in breast cancer patients: a report of feasibility and early toxicity results in the first 50 treatments. Radiat Oncol 28:145 CrossRef
  16. Darby SC, Ewertz M, McGale P et al (2012) Risk of ischemic heart disease in women after radiotherapy for breast cancer. N Engl J Med 368:987-98 CrossRef
  
• 作者单位：Kathrin Dellas MD (1) (2)
  Dr. Reinhard Vonthein (3) (4)
  J?rg Zimmer MD (5)
  Stefan Dinges MD (6)
  Alexander D. Boicev MD (7)
  Peter Andreas MD (8)
  Dorothea Fischer MD (9)
  Cornelia Winkler MD (10)
  Prof. Dr. Andreas Ziegler (3) (4)
  Prof. Jürgen Dunst MD (1) (11) (2)
  ARO Study Group
  
  1. Department of Radiooncology, University of Kiel, A.-Heller-Str. 3, 24105, Kiel, Germany
  2. Department of Radiooncology, University of Lübeck, Lübeck, Germany
  3. Institute of Medical Biometry and Statistics, University of Lübeck, University Medical Center Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
  4. Center for Clinical Trials, University of Lübeck, Lübeck, Germany
  5. Private Practice of Radiooncology, Dresden-Friedrichstadt, Dresden, Germany
  6. Department of Radiooncology, Klinikum Lüneburg, Lüneburg, Germany
  7. Department of Radiooncology, Klinikum Zwickau, Zwickau, Germany
  8. Department of Radiooncology, Krankenhaus Buchholz, Buchholz, Germany
  9. Department of Gynecology, University of Lübeck, Lübeck, Germany
  10. Department of Radiooncology, TU Munich, Munich, Germany
  11. University of Copenhagen, Copenhagen, Denmark
  
• ISSN：1439-099X

文摘

Purpose To evaluate the feasibility of hypofractionation with SIB in all settings in Germany to prepare a multicenter treatment comparison. Methods Eligible patients had histopathologically confirmed breast cancer operated by BCS. Patients received WBI 40.0 Gy in 16 fractions of 2.5 Gy. A SIB with 0.5 Gy per fraction was administered to the tumor bed, thereby giving 48.0 Gy in 16 fractions to the boost-PTV sparing heart, LAD, lung, contralateral breast. The primary study objective was feasibility, administration of specified dose in 16 fractions within 22-9 days with adherence to certain dose constraints (heart; LAD; contralateral breast); secondary endpoints were toxicity, QoL. Results 151 patients were recruited from 7 institutions between 07/11-10/12. 10 patients met exclusion criteria prior to irradiation. All but two patients (99?%) received the prescribed dose in the PTVs. Adherence to dose constraints and time limits was achieved in 89?% (95?% CI 82?% to 93?%). 11 AE were reported in 10 patients; five related to concurrent endocrine therapy. Two of the AEs were related to radiotherapy: grade 3 hot flushes in two cases. QoL remained unchanged. Conclusion Hypofractionation with a SIB is feasible and was well tolerated in this study.