CUMULATIVE RISK OF COSMETIC WORSENING FOLLOWING ULTRA HYPO-FRACTIONATED WHOLE BREAST RADIOTHERAPY WITH SIMULTANEOUS INTEGRATED BOOST: THE LARGEST REAL-WORLD DATA.

IF 6.4 1区医学 Q1 ONCOLOGY

International Journal of Radiation Oncology Biology Physics Pub Date : 2025-05-29 DOI:10.1016/j.ijrobp.2025.05.061

Dr Tabassum Wadasadawala, Dr Naseera Syeda, Dr Shraddha Kenekar, Dr Revathy Krishnamurthy, Dr Rajiv Sarin, Dr Rima Pathak, Pallavi Rane, Mr Akash Pawar, Dr Prachi Upadhyay, Dr Shalaka Joshi, Dr Vani Parmar, Dr Nita Nair, Manisha Shejwal, Sonal Chavan

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引用次数: 0

Abstract

Background: Randomised trials have shown that ultra-hypofractionated radiotherapy [uHFRT] is a safe alternative for breast radiotherapy [RT]. However, its safety in patients requiring tumour bed boost cannot be firmly established as none of the patients in the FAST trial and only a quarter of the patients in the FAST-FORWARD trial were offered tumour bed boost.

Aims and objectives: To report the real-world experience of cosmetic outcomes after whole breast irradiation with uHFRT and a simultaneous integrated boost [SIB].

Methodology: The study population comprised of 354 breast cancer patients treated with uHFRT from 2020 to 2022. All patients received SIB either with electrons (n=207) or photons (n=147) The SIB dose was 33 gray (Gy) and 32 Gy respectively for FAST (n=74) and FAST-F (n=280) protocol. Cosmesis was assessed subjectively by the physicians and the patients and objectively by the BCCT.core software. The worsening of breast cosmesis was defined as a shift of the score from any lower to higher category on a 4-point scale i.e. excellent, good, fair and poor.

Results: The median follow-up time of the cohort was 31.31 months. As per the physician ratings, cosmetic deterioration at 1 year was 17% (13%, 21%) that doubled to 34% (29%, 39%) at 2 years. Patient rated worsening was 9% (6.3%,12%) at 1 year and 15% (12%, 19%) at 2 years. Similarly, BCCT.core rating also showed temporal worsening: 17% (13%,22%) at 1 year and 33% (28%,38%) at 2 years. Multivariate analysis showed that higher BMI, post-menopausal status, women with larger breast volumes, oncoplastic surgery, receiving regional nodal irradiation and fast-forward protocol were the factors associated with higher risk of cosmetic worsening.

Conclusion: We observed that uHFRT with SIB was associated with an early cosmetic deterioration that progressively worsened over time. These real-world findings offer valuable insights to support the informed clinical decision-making.

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同时综合增强的超低分割全乳放疗后美容恶化的累积风险：最大的真实世界数据。

背景：随机试验表明，超低分割放疗（uHFRT）是乳腺放疗（RT）的一种安全选择。然而，由于FAST试验中没有患者和FAST- forward试验中只有四分之一的患者接受了肿瘤床强化治疗，因此无法确定其在需要肿瘤床强化治疗的患者中的安全性。目的和目的：报告uHFRT全乳照射和同时综合提升后的美容结果的真实经验[SIB]。方法：研究人群包括354名在2020年至2022年期间接受超高压治疗的乳腺癌患者。所有患者均接受电子（n=207）或光子（n=147） SIB治疗，FAST （n=74）和FAST- f （n=280）方案的SIB剂量分别为33 Gy和32 Gy。美容由医生和患者主观上评价，由BCCT客观评价。核心软件。乳房美容的恶化被定义为在4分制（优秀、良好、一般和差）中得分从较低到较高类别的变化。结果：中位随访时间为31.31个月。根据医生评分，1年的美容恶化率为17%(13%,21%)，2年翻倍至34%（29%,39%）。患者认为1年恶化率为9%(6.3%,12%)，2年恶化率为15%（12%,19%）。同样,BCCT。核心评分也显示时间恶化：1年为17%(13%,22%)，2年为33%（28%,38%）。多因素分析显示，较高的身体质量指数、绝经后状态、乳房体积较大的女性、肿瘤整形手术、接受局部淋巴结照射和快进方案是美容恶化风险较高的因素。结论：我们观察到伴有SIB的uHFRT与早期外观恶化相关，并随着时间的推移逐渐恶化。这些真实世界的发现为支持知情的临床决策提供了有价值的见解。

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

International Journal of Radiation Oncology Biology Physics 医学-核医学

CiteScore

11.00

自引率

7.10%

发文量

2538

审稿时长

6.6 weeks

期刊介绍： International Journal of Radiation Oncology • Biology • Physics (IJROBP), known in the field as the Red Journal, publishes original laboratory and clinical investigations related to radiation oncology, radiation biology, medical physics, and both education and health policy as it relates to the field. This journal has a particular interest in original contributions of the following types: prospective clinical trials, outcomes research, and large database interrogation. In addition, it seeks reports of high-impact innovations in single or combined modality treatment, tumor sensitization, normal tissue protection (including both precision avoidance and pharmacologic means), brachytherapy, particle irradiation, and cancer imaging. Technical advances related to dosimetry and conformal radiation treatment planning are of interest, as are basic science studies investigating tumor physiology and the molecular biology underlying cancer and normal tissue radiation response.