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首页> 外文期刊>Radiotherapy and oncology: Journal of the European Society for Therapeutic Radiology and Oncology >Randomised trial of standard 2D radiotherapy (RT) versus intensity modulated radiotherapy (IMRT) in patients prescribed breast radiotherapy.
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Randomised trial of standard 2D radiotherapy (RT) versus intensity modulated radiotherapy (IMRT) in patients prescribed breast radiotherapy.

机译：标准2D放射治疗（RT）与调强放射治疗（IMRT）的随机对照试验，用于接受乳房放射治疗的患者。

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BACKGROUND: Radiation dose distributions created by two dimensional (2D) treatment planning are responsible for partial volumes receiving >107% of the prescribed dose in a proportion of patients prescribed whole breast radiotherapy after tumour excision of early breast cancer. These may contribute to clinically significant late radiation adverse effects. AIM: To test three dimensional (3D) intensity modulated radiotherapy (IMRT) against 2D dosimetry using standard wedge compensators in terms of late adverse effects after whole breast radiotherapy. METHODS: Three hundred and six women prescribed whole breast radiotherapy after tumour excision for early stage cancer were randomised to 3D IMRT (test arm) or 2D radiotherapy delivered using standard wedge compensators (control arm). All patients were treated with 6 or 10MV photons to a dose of 50Gy in 25 fractions to 100% in 5 weeks followed by an electron boost to the tumour bed of 11.1Gy in 5 fractions to 100%. The primary endpoint was change in breast appearance scored from serial photographs taken before radiotherapy and at 1, 2 and 5 years follow up. Secondary endpoints included patient self-assessments of breast discomfort, breast hardness, quality of life and physician assessments of breast induration. Analysis was by intention to treat. RESULTS: 240 (79%) patients with 5-year photographs were available for analysis. Change in breast appearance was identified in 71/122 (58%) allocated standard 2D treatment compared to only 47/118 (40%) patients allocated 3D IMRT. The control arm patients were 1.7 times more likely to have a change in breast appearance than the IMRT arm patients after adjustment for year of photographic assessment (95% confidence interval 1.2-2.5, p=0.008). Significantly fewer patients in the 3D IMRT group developed palpable induration assessed clinically in the centre of the breast, pectoral fold, infra-mammary fold and at the boost site. No significant differences between treatment groups were found in patient reported breast discomfort, breast hardness or quality of life. CONCLUSION: This analysis suggests that minimisation of unwanted radiation dose inhomogeneity in the breast reduces late adverse effects. Incidence of change in breast appearance was statistically significantly higher in patients in the standard 2D treatment arm compared with the IMRT arm. A beneficial effect on quality of life remains to be demonstrated.
机译：背景：二维（2D）治疗计划创建的放射剂量分布负责在接受早期乳腺癌肿瘤切除术后接受全乳放疗的患者中，部分体积接受大于107％的处方剂量。这些可能会导致临床上明显的晚期放射不良反应。目的：使用标准楔形补偿器，针对全乳放疗后的后期不良反应，对二维剂量测定法进行三维（3D）强度调制放射治疗（IMRT）的测试。方法：将306例切除早期肿瘤后接受全乳放疗的妇女随机分为3D IMRT（测试组）或使用标准楔形补偿器（对照组）进行的2D放射治疗。所有患者均接受了6或10MV光子治疗，剂量为50Gy（25馏分），在5周内达到100％，然后以5馏分至100％的电子强度升至11.1Gy。主要终点是根据放疗前以及随访1、2和5年拍摄的系列照片评分的乳房外观变化。次要终点包括患者对乳房不适的自我评估，乳房硬度，生活质量以及医生对乳房硬结的评估。分析是按意向进行的。结果：240名（79％）具有5年照片的患者可供分析。在分配了标准2D治疗的71/122（58％）患者中发现了乳房外观的变化，而分配了3D IMRT的患者只有47/118（40％）。调整照像年后，对照臂患者发生乳房外观变化的可能性是IMRT臂患者的1.7倍（95％置信区间1.2-2.5，p = 0.008）。在3D IMRT组中，临床上评估出的可触及的硬结明显少得多，这些硬结在乳房的中央，胸，乳腺下and和增强部位发生。在患者报告的乳房不适，乳房硬度或生活质量方面，治疗组之间无显着差异。结论：该分析表明，使乳房中不必要的辐射剂量不均匀性最小化可减少后期不良反应。与IMRT组相比，标准2D治疗组患者的乳房外观变化发生率在统计学上显着更高。对生活质量的有益影响尚待证明。

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