Simultaneous Integrated Boost Irradiation After Breast-Conserving Surgery: Physician-Rated Toxicity and聽Cosmetic Outcome at 30 Months鈥?Follow-Up

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• 作者：Enja J. Bantema-Joppe ; M.D.^&lowast ; ; Cornelis Schilstra ; Ph.D.^&lowast ; ; Geertruida H. de Bock ; Ph.D.^&dagger ; ; Wil V. Dolsma ; M.D. ; Ph.D.^&lowast ; ; Dianne M. Busz ; M.D.^&lowast ; ; Johannes A. Langendijk ; M.D. ; Ph.D.^&lowast ; ; John H. Maduro ; M.D. ; Ph.D.^&lowast ; ; ^{j.h.maduro@umcg.nl}
• 关键词：Toxicity ; Cosmetic outcome ; Breast cancer ; Radiotherapy
• 刊名：International Journal of Radiation Oncology*Biology*Physics
• 出版年：2012
• 期刊代码：136_03603016
• 类别：med
• 出版时间：15 July, 2012
• 卷：83
• 期：4
• 页码：e471-e477
• 文件大小：226 K

摘要

| Figures/TablesFigures/Tables | ReferencesReferences<h4 class="h4">Purposeh4>To evaluate toxicity and cosmetic outcome (CO) in breast cancer survivors treated with three-dimensional conformal radiotherapy with a hypofractionated, simultaneous integrated boost (3D-CRT-SIB) and to identify risk factors for toxicity, with special focus on the impact of age.<h4 class="h4">Methods and Materialsh4>

Included were 940 consecutive disease-free patients treated for breast cancer (Stage 0-III) with 3D-CRT-SIB, after breast-conserving surgery, from 2005 to 2010. Physician-rated toxicity (Common Terminology Criteria for Adverse Events version 3.0) and CO were prospectively assessed during yearly follow-up, up to 5 years after radiotherapy. Multivariate logistic regression analyses using a bootstrapping method were performed.<h4 class="h4">Resultsh4>

At 3 years, toxicity scores of 436 patients were available. Grade 鈮? fibrosis in the boost area was observed in 8.5%, non-boost fibrosis in 49.4%, pain to the chest wall in 6.7%, and fair/poor CO in 39.7%of cases. Radiotherapy before chemotherapy was significantly associated with grade 鈮? boost fibrosis at 3 years (odds ratio [OR] 2.8, 95%confidence interval [CI] 1.3-6.0). Non-boost fibrosis was associated with re-resection (OR 2.2, 95%CI 1.2-4.0) and larger tumors (OR 1.1, 95%CI 1.0-1.1). At 1 year, chest wall pain was significantly associated with high boost dosage (OR 2.1, 95%CI 1.2-3.7) and younger age (OR 0.4, 95%CI 0.2-0.7). A fair/poor CO was observed more often after re-resection (OR 4.5, 95%CI 2.4-8.5), after regional radiotherapy (OR 2.9, 95%CI 1.2-7.1), and in larger tumors (OR 1.1, 95%CI 1.0-1.1).<h4 class="h4">Conclusionsh4>

Toxicity and CO are not impaired after 3D-CRT-SIB. Fibrosis was not significantly associated with radiotherapy parameters. Independent risk factors for fibrosis were chemotherapy after radiotherapy, re-resection, and larger tumor size. Re-resection was most predictive for worse CO. Age had an impact on chest wall pain occurrence.