Feasibility, efficacy and cosmetic effect of three-dimensional conformal external beam partial breast irradiation for the selected early stage breast cancer patients after breast-conserving surgery
XU Min, LI Jian-bin, FAN Ting-yong, SHAO Qian, LU Jie, WANG Chun-xiang, XING Jun, ZHANG Ying-jie, WANG Yong-sheng, ZUO Wen-shu
Department of Radiation Oncology, Shandong Tumor Hospital ＆ Institute;Shandong Provincial Key Laboratory of Radiation Oncology;Shandong Academy of Medical Sciences;Ji′nan 250117,China Corresponding author:LI Jian-bin, Email:lijianbin@msn.com
Abstract：Objective To explore the feasibility, efficacy and cosmetic effect of three-dimensional conformal external beam partial breast irradiation (EB-PBI) after breast-conserving surgery for the selected Chinese early stage breast cancer patients. Methods From June 2003 to December 2010, Forty-four early stage breast cancer patients underwent EB-PBI after breast-conserving surgery. Twenty patients had CT simulation scan in moderate deep inspiration breathing hold, and twenty-four patients in free breathing. EB-PBI was planned and delivered by three-dimensional conformal radiotherapy (3DCRT) with four non-coplanar beams. The prescribed dose was 3.40 Gy per fraction in thirty-nine patients and 3.85 Gy per fraction in five patients, twice per day at an interval of at least six hours, in five consecutive days. Results The number of patients with follow up time of 2,3 and 5 years were 39, 31 and 16. Grade 1 acute radiation-induced dermatitis was observed in 17 patients (39%) at three months. Cosmesis was good or excellent in all cases at six months after radiotherapy and in 95% cases at two years after radiotherapy. The 2-, 3-and 5-year local control rates were 100%, 99% and 94%, respectively. The 2-, 3-, and 5-year survival rates were all 100% and no metastases occurred. Conclusions EB-PBI delivered by 3DCRT is feasible for selected Chinese early stage breast cancer patients after breast-conserving surgery. The cosmetic effect, local control rate and long-term survival rate are satisfactory, and acute radiation toxicity is very low.
XU Min,LI Jian-bin,FAN Ting-yong et al. Feasibility, efficacy and cosmetic effect of three-dimensional conformal external beam partial breast irradiation for the selected early stage breast cancer patients after breast-conserving surgery[J]. Chinese Journal of Radiation Oncology, 2012, 21(5): 439-442.
[1] Stewart AJ, Khan AJ, Devlin PM. Partial breast irradiation:a review of techniques and indications. Br J Radiol,2010,83:369-678. [2] 李建彬,范廷勇,卢洁,等.乳腺癌保乳术后部分乳腺三维适形放疗的临床观察.中华放射肿瘤学杂志,2007,16:439-443. [3] 李建彬,刘翠翠,于金明.影像引导保乳术后部分乳腺外照射靶区的确定.中华肿瘤杂志,2008,30:721-724. [4] Kirby AM, Coles CE, Yarnold JR. Target volume definition for external beam partial breast radiotherapy:clinical, pathological and technical studies informing current approaches. Radiother Oncol,2010,94:255-263. [5] Baglan KL, Sharpe MB, Jaffray D, et al. Accelerated partial breast irradiation using 3D conformal radiationtherapy (3D-CRT). Int J Radiat Oncol Biol Phys,2003,55:302-311. [6] Holland R, Veling SH, Mravunac M. Histologic multifocality of Tis, T1－2 breast carcinomas. Implications for clinical trials of breastconserving surgery. Cancer,1985,56:979-990. [7] Vicini FA, Kestin LL, Goldstein NS. Defining the clinical target volume for patients with early-stage breast cancer treated with lumpectomy and accelerated partial breast irradiation:a pathologic analysis. Int J Radiat Oncol Biol Phys,2004,60:722-730. [8] Hector CL, Webb S, Evans PM. The dosimetric consequences of inter-fractional patient movement on conventional and intensity-modulated breast radiotherapy treatments. Radiother Oncol,2000,54:57-64. [9] 王玮,李建彬.保乳术后外照射靶区位移的确定与校正.中华放射肿瘤学杂志,2011,20:259-262. [10] Cox BW, Horst KC, Thornton S, et al. Impact of increasing margin around the lumpectomy cavity to define the planning target volume for 3D conformal external beam accelerated partial breast irradiation. Med Dosim,2007,32:254-262. [11] 李建彬,张琳,卢洁,等.保乳术后自主呼吸控制部分乳腺外照射靶区位移的研究.中华肿瘤杂志,2008,30:207-210. [12] Smith BD, Arthur DW, Buchholz TA,et al. Accelerated partial breast irradiation consensus statement from the American society for radiation oncology (ASTRO). Int J Radiat Oncol Biol Phys,2009,74:987-1000. [13] Patel RR, Christensen ME, Hodge CW, et al. Clinical outcome analysis in"high-risk"versus"low-risk"patients eligible for national surgical adjuvant breast and bowel B-39/radiation therapy oncology group 0413 trial:five-year results. Int J Radiat Oncol Biol Phys,2008,70:970-973. [14] Chen PY, Wallace M, Mitchell C, et al. Four-year efficacy, cosmesis, and toxicity using three-dimensional conformal external beam radiation therapy to deliver accelerated partial breast irradiation. Int J Radiat Oncol Biol Phys,2010,76:991-997.
2012, Vol. 21 
