乳腺癌改良根治术后内乳电子线大分割照射剂量学评估和急性不良反应、近期疗效

doi:10.3760/cma.j.cn113030-20210401-00136

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Abstract Objective To investigate the dosimetric characteristics, acute toxicity and short-term efficacy of postmastectomy hypofractionated internal mammary (IM) chain irradiation with electrons in patients with high-risk breast cancer. Methods A total of 155 patients with breast cancer who underwent modified mastectomy between November 2018 and January 2020 were selected. Among them, 137(88.4%) patients were classified as stage Ⅲ and 18(11.6%) as stage Ⅱ. All patients received standard chemotherapy, endocrine therapy and anti-Her2 targeted therapy. CTVim was divided into three subregions:CTVim1, CTVim2 and CTVim3, which represented the first, second and third intercostal IM, respectively. The planning target volume of subraclavicular region (PTVsc) was delineated. CTVcw and CTVim were irradiated with 6-15MeV electron at 43.5Gy in 15 fractions over 3 weeks. Moreover, PTVsc was irradiated with 6MV X-ray at 43.5Gy in 15 fractions over 3 weeks using two-dimensional radiotherapy (2DRT) or three-dimensional radiotherapy (3DRT). The dosimetric characteristics of CTVim, PTVsc, lung, heart, left anterior descending coronary artery (LAD) and right coronary artery (RA) were evaluated, and the acute toxicity and short-term efficacy were analyzed. Results The mean dose (Dmean) of CTVim was (43.3±2.6)Gy, D95% was (30.5±8.3)Gy, V90% was (85.0±10.5)% and V80% was (91.0±7.4)%, respectively. The corresponding parameters of CTVim1 were significantly lower than those of CTVim2 and CTVim3(allP<0.001). Body mass index exerted no significant effect on IM dose (P>0.05). Compared with 2DRT, 3DRT for SC significantly increased theDmean of CTVim[(43.4±2.6)Gy vs.(41.4±2.3)Gy,P=0.021], and the hot spot within PTVsc[V110%:(26.7±17.5) cm³ vs.(12.5±8.4) cm³,P=0.018; V120%:(6.1±5.3) cm³ vs.(2.0±2.6) cm³,P=0.023]. TheDmean of the ipsilateral lung was (9.8±1.9)Gy, and V20Gy was (19.7±4.7)%. TheDmean of heart was (3.3±1.7)Gy in the whole group,(4.7±1.4)Gy for the left-sided breast cancer and (2.6±1.2)Gy for the right-sided breast cancer, respectively. TheDmean of LAD for the left-sided breast cancer was (13.9±4.9)Gy. TheDmean of RA for the right-sided breast cancer was (7.5±3.7)Gy. The incidence rates of ≥ grade 2 acute radiation dermatitis, esophagitis and pneumonitis were 19.3%, 4.5% and 2.6%, respectively. With a median follow-up time of 20.5 months (range:9.9-41.8 months), 2 cases of chest wall recurrence, 2 regional lymph node recurrence, 6distant metastases and 1death were reported. Conclusions When hypofractionated internal mammary chain is irradiated by electrons after mastectomy, the doses to the lung, heart and coronary artery are low, and the acute toxicities are mild. However, the dose to CTVim1 is inadequate. Although short-term efficacy is high, long-term follow-up is warranted.

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	Articles by authors
	Zhang Yuanyuan
	Zhang Tingting
	Tang Yu
	Jing Hao
	Fang Hui
	Song Yongwen
	Chen Bo
	Tang Yuan
	Jin Jing
	Liu Yueping
	Lu Ningning
	Qi Shunan
	Li Ning
	Li Yexiong
	Wang Shulian

Key words： Breast neoplasm/mastectomy Internal mammary chain/postoperative electron irradiation, hypofractionation Two-dimensional radiotherapy Three-dimensional radiotherapy Treatment outcome

Received: 01 April 2021

Fund:Beijing Marathon of Hope, Cancer Foundation of China (LC2019L02)

Corresponding Authors: Wang Shulian, Email:wsl20040118@yahoo.com

Cite this article:

Zhang Yuanyuan,Zhang Tingting,Tang Yu et al. Dosimetric evaluation, acute toxicity and short-term efficacy of postmastectomy hypofractionated internal mammary chain irradiation with electrons[J]. Chinese Journal of Radiation Oncology, 2021, 30(11): 1122-1128.

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http://journal12.magtechjournal.com/Jweb_fszlx/EN/10.3760/cma.j.cn113030-20210401-00136 OR http://journal12.magtechjournal.com/Jweb_fszlx/EN/Y2021/V30/I11/1122

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