Purpose

In this multicenter phase 2 feasibility study, we investigated the impact of preoperative accelerated partial breast irradiation (PAPBI) on local control, breast fibrosis, and cosmetic outcome.

Methods and Materials

Women aged >60 years with an invasive, unifocal (mammography and magnetic resonance imaging), nonlobular adenocarcinoma of the breast were treated with PAPBI. Six weeks after radiation therapy, a wide local excision was performed. Radiation therapy consisted of 10 × 4 Gy (2010-2013) or 5 × 6 Gy (after 2013) to the tumor (gross target volume) with a 25 mm margin (20 mm from gross target volume to clinical target volume, 5 mm planning target volume).

Results

One hundred thirty-three patients treated between 2010 and 2016 were analyzed with a median follow-up of 5.0 years (0.9-8.8 years). Seventy-eight (59%) patients were treated with 10 × 4 Gy in 2 weeks and 55 (41%) patients with 5 × 6 Gy in 1 week. Eighteen postoperative complications (14%) occurred in 15 patients (11%). The proportion of patients with no to mild fibrosis in the treated part of the breast at 2 years and later time points was around 90%. Cosmesis improved over time in several patients: excellent to good cosmetic score as rated by the physician was 68% at 6 months and 92% at 5 years. Seventy-seven percent (6 months) to 82% (5 years) of patients were “satisfied” or “very satisfied” with their cosmetic outcome. Three recurrences were detected in the biopsy track and 1 recurrence in the ipsilateral breast.

Conclusions

PAPBI is a feasible method with a low postoperative complication rate, limited fibrosis, and good to excellent cosmetic outcome. The local recurrence rate was 3% at 5 years; however, no local recurrences were observed since removal of the needle biopsy track.

中文翻译：

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术前加速部分乳房照射（PAPBI）试验的五年结果。

目的

在这项多中心2期可行性研究中，我们调查了术前加速局部乳房照射（PAPBI）对局部控制，乳房纤维化和美容结局的影响。

方法与材料

年龄大于60岁且有创，单灶（乳房X线照相和磁共振成像），乳腺非小叶腺癌的女性接受PAPBI治疗。放射治疗后六周，进行了广泛的局部切除。放射疗法由10×4 Gy（2010-2013）或5×6 Gy（2013年之后）组成，对肿瘤（总目标体积）的放射治疗具有25 mm的余量（从总目标体积到临床目标体积为20 mm，规划为5 mm）目标数量）。

结果

对2010年至2016年接受治疗的133例患者进行了分析，中位随访时间为5.0年（0.9-8.8年）。七十八（59％）的患者在2周内接受了10×4 Gy的治疗，55（41％）的患者在1周内接受了5×6 Gy的治疗。15例患者（11％）发生了18例术后并发症（14％）。在2年及以后的时间点，乳房的受治疗部位中无轻度纤维化的患者比例约为90％。随着时间的推移，一些患者的美容效果得到了改善：如医生所评价的那样，优秀至良好的美容评分在6个月时为68％，在5年时为92％。77％（6个月）至82％（5年）的患者对其美容效果“满意”或“非常满意”。在活检中发现3例复发，在同侧乳房中1例复发。

结论

PAPBI是一种可行的方法，具有较低的术后并发症发生率，有限的纤维化和良好的美容效果。5年局部复发率为3％；然而，由于去除了活检针，因此未观察到局部复发。