Five-year results of the very accelerated partial breast irradiation VAPBI phase I-II GEC-ESTRO trial

IF 4.9 1区医学 Q1 ONCOLOGY

Radiotherapy and Oncology Pub Date : 2024-09-24 DOI:10.1016/j.radonc.2024.110543

Jose Luis Guinot , Cristina Gutierrez-Miguelez , Norbert Meszaros , Victor Gonzalez-Perez , Miguel Angel Santos , Dina Najjari , Andrea Slocker , Tibor Major , Csaba Polgar

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Abstract

Background and purpose

The standard partial breast postoperative treatment for early breast carcinomas with multi-catheter interstitial brachytherapy (MIBT) requires 7–8 fractions in 4–5 days as used in the APBI GEC-ESTRO phase III trial. In 2017 the GEC-ESTRO Breast Cancer Working Group started a Phase I-II trial to study if very accelerated partial breast irradiation (VAPBI) using 3–4 fractions could be equivalent.

Material

81 patients with low-risk invasive carcinomas underwent high dose rate MIBT. Mean age was 68 (51–90); 33 women received 4 fractions of 6.25 Gy in 2–3 days, and 48 subsequent patients 3 fractions of 7.45 Gy in 2 days, 36 perioperatively and 45 postoperatively.

Results

Median follow-up was 62 months, with 5-year actuarial breast recurrence of 3.4 % (two cases). One patient died due to metastasis. Pigmentation changes in the entrance of tubes remained visible only in 12.3 % in long term (skin G1 toxicity). Fibrosis or slight induration (G1) in 22.2 % and G2 in 9.9 %. No case of telangiectasia has been described. Cosmetic outcome is good or excellent in 95 % and fair in 5 %. Four tumors located in the retroareolar area showed nipple retraction.

Conclusion

VAPBI with MIBT using four fractions of 6.25 Gy or three fractions of 7.45 Gy in two or three days offers good local control, with a 5-year rate of fibrosis G2 similar to the GEC ESTRO phase III trial. VAPBI in two days is a good choice to decrease the total time of treatment, which is beneficial for the patient and reduces the workload.

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极加速乳腺部分照射 VAPBI I-II 期 GEC-ESTRO 试验的五年结果

背景和目的多导管间质近距离放射（MIBT）治疗早期乳腺癌的标准乳腺部分术后治疗需要在4-5天内进行7-8次分次治疗，如APBI GEC-ESTROⅢ期试验中使用的方法。2017年，GEC-ESTRO乳腺癌工作组启动了一项I-II期试验，研究使用3-4个分段的极加速乳腺部分照射（VAPBI）是否与之相当。材料81例低风险浸润性癌患者接受了高剂量率MIBT。平均年龄为68岁（51-90岁）；33名女性患者在2-3天内接受了4次6.25 Gy的分次照射，48名患者在2天内接受了3次7.45 Gy的分次照射，其中36名患者在围手术期接受，45名患者在术后接受。结果平均随访时间为62个月，5年精算乳腺复发率为3.4%（2例）。一名患者因转移而死亡。只有12.3%的患者在长期治疗后仍能看到管道入口处的色素变化（皮肤G1毒性）。22.2%的患者出现纤维化或轻微压痕（G1），9.9%的患者出现 G2。没有出现毛细血管扩张的病例。美容效果良好或极佳的占 95%，一般的占 5%。结论VAPBI与MIBT结合使用，在两天或三天内使用四次6.25 Gy或三次7.45 Gy的分次剂量，可提供良好的局部控制，5年纤维化G2率与GEC ESTRO III期试验相似。两天内进行 VAPBI 是一个不错的选择，可缩短治疗总时间，这对患者有利，也减轻了工作量。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Radiotherapy and Oncology 医学-核医学

CiteScore

10.30

自引率

10.50%

发文量

2445

审稿时长

45 days

期刊介绍： Radiotherapy and Oncology publishes papers describing original research as well as review articles. It covers areas of interest relating to radiation oncology. This includes: clinical radiotherapy, combined modality treatment, translational studies, epidemiological outcomes, imaging, dosimetry, and radiation therapy planning, experimental work in radiobiology, chemobiology, hyperthermia and tumour biology, as well as data science in radiation oncology and physics aspects relevant to oncology.Papers on more general aspects of interest to the radiation oncologist including chemotherapy, surgery and immunology are also published.