在对病理完全反应的乳腺癌患者进行手术去升级临床试验时，采用不同的方法来确定靶区容积和提供助推剂

IF 1.8 Q3 ONCOLOGY

Radiation Oncology Journal Pub Date : 2023-12-31 DOI:10.3857/roj.2023.00528

S. Novikov, Petr Krivorotko, Zhanna Bryantseva, I. Akulova, A. Emelyanov, V. Mortada, Olga Ponomareva, P. Krzhivitskiy, Sergey Kanaev

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引用次数: 0

摘要

目的：我们评估了对新辅助全身治疗（NST）完全反应的患者进行放疗而不进行手术的靶区界定和增量给药的各种方法。材料与方法：在 "手术去升级 "前瞻性观察研究的 27 例患者中，21 例确诊为病理完全反应（pCR）。在进行 NST 和真空抽吸活检之前，在原发肿瘤体积（PrTV）中放置夹子。20名PCR患者接受了全乳腺照射和PrTV增强治疗。高剂量率近距离放射治疗（HDRB）是增强照射的基本技术。最后，我们确定了融合图像（NST前的计算机断层扫描[CT]与模拟CT）、片段及其组合对精确照射的价值：结果：治疗前 CT 的 PrTV 与模拟 CT 的夹片定位完全重合的有 10 例，部分不匹配的有 3 例。在这 13 位女性患者中，有 12 位成功使用了 HDRB 进行推注。在 5 例患者中，我们发现融合图像上的 PrTV 与夹子的地形图存在明显差异。在另外两名患者中，我们在模拟 CT 上没有发现夹层。在这七名患者中，有五名患者的融合图像显示了用于识别肿瘤总体积的解剖标志物（疤痕、纤维化）。在所有 20 位获得 pCR（平均随访 16.6 个月）的女性患者中，没有出现局部复发：结论：将夹子与 NST 前 CT 和模拟 CT 相结合，对于准确提供助推力非常重要。

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Different approaches to target volume definition and boost delivery in surgery de-escalation clinical trial in breast cancer patients with pathological complete response

Purpose: We evaluate various approaches to target volume definition and boost delivery in patients with complete response to neoadjuvant systemic therapy (NST) who were treated by radiotherapy without a surgery. Materials and Methods: A pathological complete response (pCR) was diagnosed in 21 of 27 patients included in “surgery de-escalation” prospective observation study. Clips were placed in the primary tumor volume (PrTV) before NST and during the vacuum aspiration biopsy. Twenty patients with pCR underwent the whole breast irradiation and a boost to the PrTV. High-dose rate brachytherapy (HDRB) was the basic technique for boost delivery. Finally, we identified the value of fused images (computed tomography [CT] before NST with simulation CT), clips and their combination for an accurate boost delivery.Results: A complete overlap between PrTV on pre-treatment CT with the localization of the clips on simulation CT was mentioned in 10, partial mismatch in three patients. In 12 of these 13 women, HDRB was successfully used for the boost delivery. In five cases we mentioned a marked discrepancy between the PrTV on fused images and the topography of the clips. In other two women we did not find clips on simulation CT. The fused images in five of these seven patients showed anatomical landmarks (scar, fibrosis) used for identification of the gross tumor volume. In all 20 women with pCR (average follow-up of 16.6 months), there were no locoregional recurrences.Conclusion: Combination of the clips with fusion of pre-NST and simulation CTs is important for an accurate boost delivery.

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来源期刊

Radiation Oncology Journal ONCOLOGY-

CiteScore

3.50

自引率

4.30%

发文量