The impact of fractionation on secondary malignancies in postoperative breast cancer irradiation

IF 5.7 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Breast Pub Date : 2024-10-05 DOI:10.1016/j.breast.2024.103819

Sophia Kiesl , Mathias Düsberg , Sophie T. Behzadi , Rebecca Moser , Jana Nano , Thomas Huber , Evelyn Klein , Marion Kiechle , Denise Bernhardt , Stephanie E. Combs , Kai J. Borm

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引用次数: 0

Abstract

Purpose

Randomized studies demonstrated the oncological equivalence of (ultra-)hypofractionation compared to a 5-week schedule in postoperative radiotherapy of breast cancer. Due to the low incidence and long latency of secondary malignancies, there are currently no reliable clinical data regarding the influence of fractionation regimens on the development of secondary malignancies.

Material and methods

For 20 patients with right or left-sided breast cancer, postoperative treatment plans were created using 3D-CRT (n = 10) or VMAT (n = 10) for three different fractionation schedules: 5-week schedule with 50.4Gy in 1.8Gy (28fx), hypofractionation with 40.05Gy in 2.67Gy (15fx) and ultra-hypofractionation with 26Gy in 5.2Gy (5fx). The EARs (absolute additional cases of disease per 10,000 patient-years) for secondary malignancies in the lung, contralateral breast, esophagus, liver, thyroid, spinal cord, bones and soft tissue were calculated using a fraction-dependent dose-response model.

Results

Based on risk modulation, (ultra-)hypofractionation resulted in significantly lower EARs for lung cancer (LC), contralateral breast cancer (CBC) and soft tissue sarcoma (STS) (p < .001). For the ultra-hypofractionated dose concept the median EARs for LC, CBC and STS were 42.8 %, 39.4 % and 58.1 % lower compared to conventional fractionation and 31.2 %, 25.7 % and 20.3 % compared to hypofractionation. The influence of fractionation on the risk of secondary malignancies for LC and CBC was less pronounced with 3D-CRT than with VMAT. For STS, however, the influence of fractionation was greater with 3D-CRT than with VMAT.

Conclusion

Based on this simulation study (ultra-)hypofractionated postoperative breast cancer irradiation may be associated with a lower risk of secondary malignancies compared to a 5-week schedule.

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乳腺癌术后照射中分次照射对继发性恶性肿瘤的影响。

目的：随机研究表明，在乳腺癌术后放疗中，（超）低分次与5周计划相比，在肿瘤学上具有等效性。由于继发性恶性肿瘤的发病率低且潜伏期长，目前还没有关于分次方案对继发性恶性肿瘤的影响的可靠临床数据：对20名右侧或左侧乳腺癌患者，采用3D-CRT（n = 10）或VMAT（n = 10）三种不同的分层方案制定术后治疗计划：5周计划：1.8Gy中含50.4Gy（28fx）；2.67Gy中含40.05Gy（15fx）；5.2Gy中含26Gy（5fx）。采用分量依赖性剂量-反应模型计算了肺部、对侧乳腺、食道、肝脏、甲状腺、脊髓、骨骼和软组织继发性恶性肿瘤的 EARs（每 10,000 患者年新增疾病绝对病例数）：结果：根据风险调节，（超）低分量治疗可显著降低肺癌（LC）、对侧乳腺癌（CBC）和软组织肉瘤（STS）的 EARs（p 结论：（超）低分量治疗可显著降低肺癌、对侧乳腺癌和软组织肉瘤的 EARs（p根据这项模拟研究，与 5 周计划相比，乳腺癌术后（超）低分次照射可能会降低继发性恶性肿瘤的风险。

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

Breast 医学-妇产科学

CiteScore

8.70

自引率

2.60%

发文量

165

审稿时长

59 days

期刊介绍： The Breast is an international, multidisciplinary journal for researchers and clinicians, which focuses on translational and clinical research for the advancement of breast cancer prevention, diagnosis and treatment of all stages.