FRACTIONATION FOR WHOLE BREAST IRRADIATION: AN AMERICAN SOCIETY FOR RADIATION ONCOLOGY (ASTRO) EVIDENCE-BASED GUIDELINE

被引:305
作者
Smith, Benjamin D. [1 ]
Bentzen, Soren M. [2 ]
Correa, Candace R. [3 ]
Hahn, Carol A. [4 ]
Hardenbergh, Patricia H. [5 ]
Ibbott, Geoffrey S. [6 ]
McCormick, Beryl [7 ]
McQueen, Julie R. [8 ]
Pierce, Lori J. [3 ]
Powell, Simon N. [7 ]
Recht, Abram [9 ,10 ]
Taghian, Alphonse G. [11 ]
Vicini, Frank A. [12 ]
White, Julia R. [13 ]
Haffty, Bruce G. [14 ]
机构
[1] Univ Texas MD Anderson Canc Ctr, Dept Radiat Oncol, Houston, TX 77030 USA
[2] Univ Wisconsin, Dept Human Oncol, Sch Med & Publ Hlth, Madison, WI USA
[3] Univ Michigan, Dept Radiat Oncol, Ann Arbor, MI 48109 USA
[4] Duke Univ, Med Ctr, Dept Radiat Oncol, Durham, NC USA
[5] Shaw Reg Canc Ctr, Vail, CO USA
[6] Univ Texas MD Anderson Canc Ctr, Dept Radiat Phys, Houston, TX 77030 USA
[7] Mem Sloan Kettering Canc Ctr, Dept Radiat Oncol, New York, NY 10021 USA
[8] Duke Raleigh Canc Ctr, Durham, NC USA
[9] Harvard Univ, Sch Med, Dept Radiat Oncol, Boston, MA USA
[10] Beth Israel Deaconess Med Ctr, Boston, MA 02215 USA
[11] Massachusetts Gen Hosp, Dept Radiat Oncol, Boston, MA 02114 USA
[12] Beaumont Canc Inst, Dept Radiat Oncol, Royal Oak, MI USA
[13] Med Coll Wisconsin, Dept Radiat Oncol, Milwaukee, WI 53226 USA
[14] Canc Inst New Jersey, Dept Radiat Oncol, New Brunswick, NJ USA
来源
INTERNATIONAL JOURNAL OF RADIATION ONCOLOGY BIOLOGY PHYSICS | 2011年 / 81卷 / 01期
关键词
Breast cancer; Hypofractionation; Evidence-based guideline; Breast conserving therapy; RANDOMIZED CLINICAL-TRIAL; AXILLARY DISSECTION; RADIOTHERAPY HYPOFRACTIONATION; UK STANDARDIZATION; CANCER; THERAPY; WOMEN; LUMPECTOMY; EXCISION; BOOST;
D O I
10.1016/j.ijrobp.2010.04.042
中图分类号
R73 [肿瘤学];
学科分类号
100214 ;
摘要
Purpose: In patients with early-stage breast cancer treated with breast-conserving surgery, randomized trials have found little difference in local control and survival outcomes between patients treated with conventionally fractionated (CF-) whole breast irradiation (WBI) and those receiving hypofractionated (HF)-WBI. However, it remains controversial whether these results apply to all subgroups of patients. We therefore developed an evidence-based guideline to provide direction for clinical practice. Methods and Materials: A task force authorized by the American Society for Radiation Oncology weighed evidence from a systematic literature review and produced the recommendations contained herein. Results: The majority of patients in randomized trials were aged 50 years or older, had disease Stage pT1-2 pN0, did not receive chemotherapy, and were treated with a radiation dose homogeneity within +/- 7% in the central axis plane. Such patients experienced equivalent outcomes with either HF-WBI or CF-WBI. Patients not meeting these criteria were relatively underrepresented, and few of the trials reported subgroup analyses. For patients not receiving a radiation boost, the task force favored a dose schedule of 42.5 Gy in 16 fractions when HF-WBI is planned. The task force also recommended that the heart should be excluded from the primary treatment fields (when HF-WBI is used) due to lingering uncertainty regarding late effects of HF-WBI on cardiac function. The task force could not agree on the appropriateness of a tumor lied boost in patients treated with HF-WBI. Conclusion: Data were sufficient to support the use of HF-WBI for patients with early-stage breast cancer who met all the aforementioned criteria. For other patients. the task force could not reach agreement either for or against the use of HF-WBI, which nevertheless should not be interpreted as a contraindication to its use. Copyright (C) 2011 American Society for Radiation Oncology. Published by Elsevier Inc.
引用
收藏
页码:59 / 68
页数:10
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