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Strahlentherapie und Onkologie

, Volume 190, Issue 5, pp 444–450 | Cite as

Accelerated partial breast irradiation with external beam three-dimensional conformal radiotherapy

Five-year results of a prospective phase II clinical study
  • Emöke Mózsa
  • Norbert Mészáros
  • Tibor Major
  • Georgina Fröhlich
  • Gábor Stelczer
  • Zoltán Sulyok
  • János Fodor
  • Csaba PolgárEmail author
Original article

Abstract

Purpose

The aim of this study was to report the 5-year results of accelerated partial breast irradiation (APBI) using external beam three-dimensional conformal radiotherapy (3D-CRT).

Patients and methods

Between 2006 and 2011, 44 patients with low-risk, stage I–II breast cancer underwent breast-conserving surgery. Postoperative APBI was given by means of 3D-CRT using three to five non-coplanar fields. The total dose of APBI was 36.9 Gy (nine fractions of  4.1 Gy b.i.d.). The mean follow-up time was 58.2 months for surviving patients. Survival results, side effects, and cosmetic results were assessed.

Results

One (2.3 %) local recurrence was observed, for a 5-year actuarial rate of 3.7 %. Neither regional nor distant failure was observed. Two patients died of internal disease. The 5-year disease-free, cancer-specific, and overall survival rates were 96.3, 100, and 95.1 %, respectively. Acute side effects included grade 1 (G1) erythema in 75 %, G1 parenchymal induration in 46 %, and G1 pain in 46 % of patients. No G2 or higher acute side effect occurred. Late side effects included G1, G2, and G3 fibrosis in 44, 7, and 2 % of patients, respectively, G1 skin pigmentation in 12 %, and G1 pain in 2 %. Asymptomatic fat necrosis occurred in 14 %. Cosmetic results were rated excellent or good in 86 % of cases by the patients themselves and 84 % by the physicians.

Conclusions

The 5-year local tumor control, toxicity profile, and cosmetic results of APBI delivered with external beam 3D-CRT are encouraging and comparable to other APBI series.

Keywords

Breast cancer Accelerated partial breast irradiation Three-dimensional conformal radiotherapy Phase II clinical trial Tumor control 

Akzelerierte perkutane dreidimensionale konformale Teilbrustbestrahlung

5-Jahres-Ergebnisse einer prospektiven Phase-II-Studie

Zusammenfassung

Ziel

Evaluation der 5-Jahres-Ergebnisse bezüglich Überleben, Tumorkontrolle, Nebenwirkungen und Kosmetik nach Teilbrustbestrahlung (APBI) mittels 3-D-konformaler, akzelerierter Radiotherapie (3D-CRT).

Patienten und Methoden

Zwischen 2006 und 2011 wurden 44 Patienten mit Brustkrebs im Stadium I–II und niedrigem Risikoprofil brusterhaltend operiert. Die adjuvante, 3-D-konformale APBI wurde mittels 3–5 nonkoplanarer Feldern durchgeführt. Die Gesamtdosis betrug 36,9 Gy bei 9 -mal  4,1 Gy b.i.d.. Nach einer mittleren Nachbeobachtungszeit von 58,2 Monaten wurden die Überlebensrate, die Tumorkontrolle, die Nebenwirkungen und die Kosmetik evaluiert.

Ergebnisse

Lediglich ein Lokalrezidiv wurde nachgewiesen (2,3 %) bei einer statistischen 5-Jahres-Rate von 3,7 %. Keine weiteren lokoregionären Rezidive oder Fernmetastasen wurden beobachtet. Es verstarben 2 Patientinnen aufgrund internistischer Erkrankungen. Das krankheitsfreie-, tumorspezifische- und 5-Jahres-Gesamtüberleben war 96,3, 100 und 95,1 %. Es wurden lediglich Grad-1 Akutnebenwirkungen beobachtet: Erythem in 75 %, parenchymale Induration in 46 % und Schmerzen in 46 %, jedoch keine höhergradigen Akuttoxizitäten. An chronischen Nebenwirkungen Grad-1 wurden Hyperpigmentation in 12 %, Schmerzen in 2 % und Fibrosen in 44 % diagnostiziert, Letztere entwickelte sich auch höhergradig (Grad 2 in 7 %, Grad 3 in 2 %). Asymtomatische Fettnekrosen traten in 14 % auf. Die Kosmetik wurde von 86 % der Patientinnen als ausgezeichnet/gut beurteilt, von den Ärzten in 84 %.

Schlussfolgerung

Die lokale Kontrolle nach 5 Jahren, die Toxizität und die Kosmetik nach APBI mittels 3-D-konformaler Radiotherapie ist ermutigend und unsere Beobachtung entspricht den Daten anderer APBI-Veröffentlichungen.

Schlüsselwörter

Brustkrebs Akzelerierte Teilbrustbestrahlung Dreidimensionale konformale Radiotherapie Klinische Phase-II-Studie Tumorkontrolle 

Notes

Acknowledgments

The trial was registered at ClinicalTrials.gov with an Identifier number of NCT02003560. We acknowledge the contributions of Katalin Lövey MD and Levente Jánváry MD, who previously worked on the trial, treated patients, and contributed to follow-up of patients and data collection.

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Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • Emöke Mózsa
    • 1
    • 3
  • Norbert Mészáros
    • 1
  • Tibor Major
    • 1
  • Georgina Fröhlich
    • 1
  • Gábor Stelczer
    • 1
  • Zoltán Sulyok
    • 2
  • János Fodor
    • 1
  • Csaba Polgár
    • 1
    Email author
  1. 1.Centre of RadiotherapyNational Institute of OncologyBudapestHungary
  2. 2.Centre of SurgeryNational Institute of OncologyBudapestHungary
  3. 3.Department of Radiooncology and RadiotherapyLandesklinikum Wiener NeustadtWiener NeustadtAustria

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