Response to 'Unacceptable cosmesis in a protocol investigating intensity-modulated radiotherapy with active breathing control for accelerated partial-breast irradiation' (Int J Radiat Oncol Biol Phys 2010;76:71-78) and Toxicity of three-dimensional conformal radiotherapy for accelerated partial breast irradiation' Int J Radiat Oncol Biol Phys 2009;75:1290-1296).

摘要

Jagsi et al. (1) recently reported cosmetic outcomes from a single-institution trial of 34 early-stage breast cancer patients treated with breast-conserving surgery followed by accelerated partial-breast irradiation (APBI). Intensity-modulated radiotherapy was used in a breathholding fashion with 38.5 Gy in 3.85-Gy fractions twice daily. The authors noted that the dose and fractionation schedule used in their study was identical to that prescribed in NS ABP B-39/RTOG-0413 and that retrospective analysis demonstrated that all but one treatment plan adhered to the dosimetric requirements of the large national trial. Seven (20.6%) patients had unacceptable cosmesis. The authors concluded that the hypofractionated schedule and parameters they used, those commonly used for external-beam APBI as well as in the B-39/RTOG trial, appear suboptimal based on the toxicity they saw.In a second article, Hepel et al. (2) reported a 25% Grade 2-3 and 8.3% Grade 3-4 subcutaneous fibrosis late toxicity (median 15-month follow-up) in 60 patients treated with three-dimensional conformal external beam therapy in the manner dictated in the B-39/RTOG trial. Ten percent of patients developed late Grade 3-4 toxicities. This relatively high rate of normal tissue injury was found despite adherence to the dose/volume parameters outlined in the NSABP/RTOG protocol and was associated with marked cosmetic compromise. The authors noted that their conclusions were limited because of small sample size.