J Breast Cancer.  2014 Sep;17(3):256-264. 10.4048/jbc.2014.17.3.256.

Accelerated Partial Breast Irradiation with Intensity-Modulated Radiotherapy Is Feasible for Chinese Breast Cancer Patients

• He Z
• Wu S
• Zhou J
• Li F
• Sun J
• Lin Q
• Lin H
• Guan X

• KMID: 2286353
• DOI: http://doi.org/10.4048/jbc.2014.17.3.256

Abstract

PURPOSE
Several accelerated partial breast irradiation (APBI) techniques are being investigated in patients with early-stage breast cancer. The present study evaluated the feasibility, early toxicity, initial efficacy, and cosmetic outcomes of accelerated partial breast intensity-modulated radiotherapy (IMRT) for Chinese female patients with early-stage breast cancer after breast-conserving surgery.
METHODS
A total of 38 patients met the inclusion criteria and an accelerated partial breast intensity-modulated radiotherapy (APBI-IMRT) plan was designed for each patient. The prescription dose was 34 Gy in 10 fractions, 3.4 Gy per fraction, twice a day, in intervals of more than 6 hours.
RESULTS
Of the 38 patients, six patients did not meet the planning criteria. The remaining 32 patients received APBI-IMRT with a mean target volume conformity index of 0.67 and a dose homogeneity index of 1.06. The median follow-up time was 53 months and no local recurrence or distant metastasis was detected. The most common acute toxicities observed within 3 months after radiotherapy were erythema, breast edema, pigmentation, and pain in the irradiated location, among which 43.8%, 12.5%, 31.3%, and 28.1% were grade 1 toxicities, respectively. The most common late toxicities occurring after 3 months until the end of the follow-up period were breast edema, pigmentation, pain in the irradiated location, and subcutaneous fibrosis, among which 6.2%, 28.1%, 21.9%, and 37.5% were grade 1 toxicities, respectively. Thirty-one patients (96.8%) had fine or excellent cosmetic outcomes, and only one patient had a poor cosmetic outcome.
CONCLUSION
It is feasible for Chinese females to receive APBI-IMRT after breast conserving surgery. The radiotherapeutic toxicity is acceptable, and both the initial efficacy and cosmetic outcomes are good.

Keyword

Breast neoplasms; Intensity-modulated radiotherapy; Segmental mastectomy

MeSH Terms

Asian Continental Ancestry Group*
Breast Neoplasms*
Breast*
Edema
Erythema
Female
Fibrosis
Follow-Up Studies
Humans
Mastectomy, Segmental
Neoplasm Metastasis
Pigmentation
Prescriptions
Radiotherapy
Radiotherapy, Intensity-Modulated*
Recurrence

Figure

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  Figure 1 Delineation of the surgical cavity (white arrows) based on surgical clips (A), seroma (B), and ultrasound (C).

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  Figure 2 Dose distribution of two patients off-protocol. (A) Case 23 with tumor located in low inner quadrant, dose of heart and ipsilateral lung is in excess of the evaluation criteria of RTOG-0319. (B) Case 24 with tumor located in upper outer quadrant, dose of uninvolved normal breast is in excess of the evaluation criteria of RTOG-0319.

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