Tumors of female reproductive systemTumors of female reproductive systemОпухоли женской репродуктивной системы1994-40981999-8627Publishing House ABV Press55710.17650/1994-4098-2017-13-4-10-18MAMMOLOGY. ORIGINAL REPORTSМАММОЛОГИЯ. ОРИГИНАЛЬНЫЕ СТАТЬИRESULTS OF EARLY-STAGE BREAST CANCER PATIENTS’ TREATMENT USING ACCELERATED PARTIAL BREAST IRRADIATION TECHNIQUE AFTER BREAST-CONSERVING SURGERY. EXPERIENCE OF N.N. BLOKHIN NATIONAL MEDICAL RESEARCH CENTER OF ONCOLOGYРЕЗУЛЬТАТЫ ЛЕЧЕНИЯ БОЛЬНЫХ РАННИМ РАКОМ МОЛОЧНОЙ ЖЕЛЕЗЫ ПО МЕТОДУ УСКОРЕННОГО ЧАСТИЧНОГО ОБЛУЧЕНИЯ ПОСЛЕ ОРГАНОСОХРАНЯЮЩИХ ОПЕРАЦИЙ. ОПЫТ ФГБУ «НМИЦ ОНКОЛОГИИ ИМ. Н.Н. БЛОХИНА» МИНЗДРАВА РОССИИTrofimovaO. P.ТрофимоваО. П.
Russian Federation

23 Kashirskoe Shosse, Moscow 115478; 2/1 Barrikadnaya St., Moscow 123993

Оксана Петровна Трофимова - Кафедра онкологии РМАНПО.

115478 Москва, Каширское шоссе, 23; 123993 Москва, ул. Баррикадная, 2/1

dr.Trofimova@mail.ruVolkovaN. V.ВолковаН. В.
Russian Federation

23 Kashirskoe Shosse, Moscow 115478

115478 Москва, Каширское шоссе, 23

NazarenkoA. V.НазаренкоА. В.
Russian Federation

23 Kashirskoe Shosse, Moscow 115478

115478 Москва, Каширское шоссе, 23

KolyadinaI. V.КолядинаИ. В.
Russian Federation

2/1 Barrikadnaya St., Moscow 123993

Кафедра онкологии.

123993 Москва, ул. Баррикадная, 2/1

HaylenkoV. A.ХайленкоВ. А.
Russian Federation

23 Kashirskoe Shosse, Moscow 115478

115478 Москва, Каширское шоссе, 23

TkachevS. I.ТкачевС. И.
Russian Federation

23 Kashirskoe Shosse, Moscow 115478

115478 Москва, Каширское шоссе, 23

PryamikovaJ. I.ПрямиковаЮ. И.
Russian Federation

23 Kashirskoe Shosse, Moscow 115478

115478 Москва, Каширское шоссе, 23

TimoshkinaE. V.ТимошкинаЕ. В.
Russian Federation

23 Kashirskoe Shosse, Moscow 115478

115478 Москва, Каширское шоссе, 23

ZaychenkoO. S.ЗайченкоО. С.
Russian Federation

23 Kashirskoe Shosse, Moscow 115478

115478 Москва, Каширское шоссе, 23

BoldyrevaV. A.БолдыреваВ. А.
Russian Federation

23 Kashirskoe Shosse, Moscow 115478

115478 Москва, Каширское шоссе, 23

VorotnikovI. K.ВоротниковИ. К.
Russian Federation

23 Kashirskoe Shosse, Moscow 115478

115478 Москва, Каширское шоссе, 23

AlievaS. B.АлиеваС. Б.
Russian Federation

23 Kashirskoe Shosse, Moscow 115478

115478 Москва, Каширское шоссе, 23

BorisovaT. N.БорисоваТ. Н.
Russian Federation

23 Kashirskoe Shosse, Moscow 115478

115478 Москва, Каширское шоссе, 23

GlebovskayaV. V.ГлебовскаяВ. В.
Russian Federation

23 Kashirskoe Shosse, Moscow 115478

115478 Москва, Каширское шоссе, 23

IvanovS. M.ИвановС. М.
Russian Federation

23 Kashirskoe Shosse, Moscow 115478

115478 Москва, Каширское шоссе, 23

N.N. Blokhin National Medical Research Center of Oncology, Ministry of Health of RussiaФГБУ «Национальный медицинский исследовательский центр онкологии им. Н.Н. Блохина» Минздрава РоссииRussian Medical Academy of Continuous Professional Education at the Ministry of Health of RussiaФГБОУ ДПО «Российская медицинская академия непрерывного профессионального образования» Минздрава России2112201713410182212201722122017https://ojrs.abvpress.ru/ojrs/article/view/557

Objective: to analyze the results of early-stage breast cancer patients’ treatment using accelerated partial breast irradiation technique after breast-conserving surgery.

Materials and methods. The study enrolled 100 patients with histologically proven breast cancer pT1–2N0–micM0 who were treated in N.N. Blokhin National Medical Research Center of Oncology in 2008–2017. Median age – 65 years, median of follow-up – 36 months. All patients underwent breast-conserving surgical treatment (radical resection), radiation therapy and hormonal therapy if needed. Radiation therapy was performed in accelerated partial breast irradiation technique. All patients corresponded strict selection bias. For proper visualization and accurate delineation of tumor bed 94 % underwent clipping with radiopaque metal clips. All patients were treated with 3D-conformal radiation therapy in 2.5 Gy per fraction twice a day, overall dose 40 Gy (in 16 fractions).

Results. Median follow-up was 36 months. No locoregional recurrences or distant metastases were observed. Excellent and good cosmetic results were observed in 96 % patients.

Conclusions. Accelerated partial breast irradiation in very selected patients after breast-conserving surgery gives excellent clinical results, quite similar with those after whole breast irradiation.

Цель исследования – анализ результатов лечения больных ранним раком молочной железы (РМЖ) по разработанной методике ускоренного частичного облучения молочной железы после органосохраняющих операций.

Материалы и методы. В исследование были включены 100 пациенток с верифицированным РМЖ в стадиях pT1–2N0–micM0, проходивших лечение в ФГБУ «Национальный медицинский исследовательский центр онкологии им. Н.Н. Блохина» Минздрава России в 2008–2017 гг. Медиана возраста пациенток – 65 лет, медиана наблюдения – 36 мес. Всем пациенткам проведено органосохраняющее лечение, включающее радикальные резекции, лучевую терапию, по показаниям – гормональную терапию. Лучевая терапия в нашем исследовании выполнена по методике ускоренного частичного облучения. Все пациентки полностью соответствовали строгим критериям отбора. Для четкой визуализации и адекватного определения объема лучевого воздействия у 96 % пациенток проведено клипирование ложа удаленной опухоли рентгеноконтрастными металлическими клипсами. Все пациентки получили 3D-конформную лучевую терапию в разовой очаговой дозе 2,5 Гр 2 раза в день до суммарной очаговой дозы 40 Гр (всего 16 фракций).

Результаты. При медиане наблюдения 36 мес локальные и локорегионарные рецидивы, отдаленные метастазы не отмечены ни у одной пациентки. Отличные и хорошие косметические результаты лечения зафиксированы у 96 % пациенток.

Выводы. Проведение ускоренного частичного облучения молочной железы у тщательно отобранных больных ранним РМЖ после органосохраняющих операций показывает результаты лечения, сопоставимые с результатами после проведения облучения всей молочной железы.

radiation therapy, breast cancer, local recurrenceлучевая терапиярак молочной железылокальный рецидивЗлокачественные новообразования в России в 2015 г. (заболеваемость и смертность). Под ред. А.Д. Каприна, В.В. Старинского, Г.В. Петровой. М.: МНИОИ им. П.А. Герцена – филиал ФГБУ «НМИЦР» Минздрава России, 2017. С. 10–12. [Malignant tumors in Russia in 2014 (morbidity and mortality). Eds. A.D. Kaprin, V.V. Starinskiy, G.V. Petrova. Moscow: MNIOI im. P.A. Gertsena – filial FGBU “NMIRTS” Minzdrava Rossii, 2017. Pp. 10–12. (In Russ.)].1. Clarke M., Collins R., Darby S. et al. Effects of radiotherapy and of differences in thе extent of surgery for early breast cancer on local recurrence and 15-year survival: an overview of randomized trials. Lancet 2005;366(9503):2087–106. DOI: 10.1016/S0140-6736(05)67887-7.Clarke M., Collins R., Darby S. et al. Effects of radiotherapy and of differences in thе extent of surgery for early breast cancer on local recurrence and 15-year survival: an overview of randomized trials. Lancet 2005;366(9503):2087–106. DOI: 10.1016/S0140-6736(05)67887-7.2. Fisher B., Anderson S., Bryant J. et al. Twenty-year follow-up of a randomized trial comparing total mastectomy, lumpectomy and lumpectomy plus irradiation for the treatment of invasive breast cancer. N Engl J Med 2002;347(16):1233–41. DOI: 10.1056/NEJMoa022152.Fisher B., Anderson S., Bryant J. et al. Twenty-year follow-up of a randomized trial comparing total mastectomy, lumpectomy and lumpectomy plus irradiation for the treatment of invasive breast cancer. N Engl J Med 2002;347(16):1233–41. DOI: 10.1056/NEJMoa022152.3. Formenti S.C., Arslan A.A., Pike M.C. Longterm outcomes of invasive ipsilateral breast tumor recurrences after lumpectomy in NSABP B-17 and B-24 randomized clinical trials for DCIS. J Natl Cancer Inst 2011;103(6): 478–88. DOI: 10.1093/jnci/djr027.Formenti S.C., Arslan A.A., Pike M.C. Longterm outcomes of invasive ipsilateral breast tumor recurrences after lumpectomy in NSABP B-17 and B-24 randomized clinical trials for DCIS. J Natl Cancer Inst 2011;103(6): 478–88. DOI: 10.1093/jnci/djr027.4. Darby S., McGale P., Correa C. et al. Effect of radiotherapy after breast-conserving surgery on 10-year recurrence and 15-year breast cancer death: meta-analysis of individual patient data for 10 801 women in 17 randomized trials. Lancet 2011;378(9804):1707–16. DOI: 10.1016/S0140-6736(11)61629-2.Darby S., McGale P., Correa C. et al. Effect of radiotherapy after breast-conserving surgery on 10-year recurrence and 15-year breast cancer death: meta-analysis of individual patient data for 10 801 women in 17 randomized trials. Lancet 2011;378(9804):1707–16. DOI: 10.1016/S0140-6736(11)61629-2.5. Bentzen S.M., Agrawal R.K., Barrett J.M. et al. The UK Standartisation of Breast Radiotherapy (START) Trial A of radiotherapy hypofractionation for treatment of early breast cancer: a randomized trial. Lancet 2008;9(4):331–41. DOI: 10.1016/S1470-2045(08)70077-9.Bentzen S.M., Agrawal R.K., Barrett J.M. et al. The UK Standartisation of Breast Radiotherapy (START) Trial A of radiotherapy hypofractionation for treatment of early breast cancer: a randomized trial. Lancet 2008;9(4):331–41. DOI: 10.1016/S1470-2045(08)70077-9.6. Bentzen S.M., Agrawal R.K., Aird E.G. et al. The UK Standardisation of Breast Radiotherapy (START) Trial B of radiotherapy hypofractionation for treatment of early breast cancer: a randomized trial. Lancet 2008;371(9618):1098–107. DOI: 10.1016/S0140-6736(08)60348-7.Bentzen S.M., Agrawal R.K., Aird E.G. et al. The UK Standardisation of Breast Radiotherapy (START) Trial B of radiotherapy hypofractionation for treatment of early breast cancer: a randomized trial. Lancet 2008;371(9618):1098–107. DOI: 10.1016/S0140-6736(08)60348-7.7. Whelan T., Pignol J.P., Levine M.N. et al. Long-term results of hypofractionated radiation therapy for breast cancer. N Engl J Med 2010;362(6):513–20. DOI: 10.1056/NEJMoa0906260Whelan T., Pignol J.P., Levine M.N. et al. Long-term results of hypofractionated radiation therapy for breast cancer. N Engl J Med 2010;362(6):513–20. DOI: 10.1056/NEJMoa09062608. Athas W.F., Adams-Cameron M., Hunt W.C. et al. Travel distance to radiation therapy and receipt of radiotherapy following breast-conserving surgery. J Natl Cancer Inst 2000;92(3):269–71. PMID: 10655446.Athas W.F., Adams-Cameron M., Hunt W.C. et al. Travel distance to radiation therapy and receipt of radiotherapy following breast-conserving surgery. J Natl Cancer Inst 2000;92(3):269–71. PMID: 10655446.9. Kong A.L, Yen T.W., Pezzin L.E. Socioeconomic and racial differences in treatment for breast cancer at a low-volume hospital. Ann Surg Oncol 2011;18(11):3220–7. DOI: 10.1245/s10434-011-2001-z.Kong A.L, Yen T.W., Pezzin L.E. Socioeconomic and racial differences in treatment for breast cancer at a low-volume hospital. Ann Surg Oncol 2011;18(11):3220–7. DOI: 10.1245/s10434-011-2001-z.10. Acharya S., Michalaski J.M. Distance to radiation facility and treatment choice in early-stage breast cancer. Int J Radiat Oncol Biol Phys 2016;94(4):691–9. DOI: 10.1016/j.ijrobp.2015.12.020.Acharya S., Michalaski J.M. Distance to radiation facility and treatment choice in early-stage breast cancer. Int J Radiat Oncol Biol Phys 2016;94(4):691–9. DOI: 10.1016/j.ijrobp.2015.12.020.11. Blom Goldman U., Wennberg B., Svane G. et al. Reduction of radiation pneumonitis by V20-constraints in breast cancer. Radiat Oncol 2010;5:99. DOI: 10.1186/1748-717X-5-99.Blom Goldman U., Wennberg B., Svane G. et al. Reduction of radiation pneumonitis by V20-constraints in breast cancer. Radiat Oncol 2010;5:99. DOI: 10.1186/1748-717X-5-99.12. Darby S.C., Ewertz M., McGale P. et al. Risk of ischemic heart disease in women after radiotherapy for breast cancer. N Engl J Med 2013;368(11):987–98. DOI: 10.1056/NEJMoa1209825.Darby S.C., Ewertz M., McGale P. et al. Risk of ischemic heart disease in women after radiotherapy for breast cancer. N Engl J Med 2013;368(11):987–98. DOI: 10.1056/NEJMoa1209825.13. Mukesh M.B., Harris E., Collette S. et al. Normal tissue complication probability (NTCP) parameters for breast fibrosis. Pooled results from 2 randomised trials. Radiother Oncol 2013;108(2):293–8. DOI: 10.1016/j.radonc.2013.07.006.Mukesh M.B., Harris E., Collette S. et al. Normal tissue complication probability (NTCP) parameters for breast fibrosis. Pooled results from 2 randomised trials. Radiother Oncol 2013;108(2):293–8. DOI: 10.1016/j.radonc.2013.07.006.14. Поддубная И.В., Комов Д.В., Колядина И.В. Локальные рецидивы рака молочной железы. М.: Медиа Медика, 2010. С. 4–6, 23–25. [Poddubnaya I.V., Komov D.V., Kolyadina I.V. Local recurrence of breast cancer. Moscow: Media Medika, 2010. Pp. 4–6, 23–25. (In Russ.)].Поддубная И.В., Комов Д.В., Колядина И.В. Локальные рецидивы рака молочной железы. М.: Медиа Медика, 2010. С. 4–6, 23–25. [Poddubnaya I.V., Komov D.V., Kolyadina I.V. Local recurrence of breast cancer. Moscow: Media Medika, 2010. Pp. 4–6, 23–25. (In Russ.)].15. Arnone P., Zurrida S., Leonardi M.C. et al. Accelerated partial breast irradiation in early breast cancer: focus on intraoperative treatment with electrons (ELIOT). Womens Health (Lond) 2012;8(1):89–98. DOI: 10.2217/whe.11.86.Arnone P., Zurrida S., Leonardi M.C. et al. Accelerated partial breast irradiation in early breast cancer: focus on intraoperative treatment with electrons (ELIOT). Womens Health (Lond) 2012;8(1):89–98. DOI: 10.2217/whe.11.86.16. Jagsi R., Ben-David M.A. Unacceptable cosmesis in a protocol investigating intensity-modulated radiotherapy with active breathing control for accelerated partial-breast irradiation. J Radiat Oncol Biol Phys 2010;76(1):71–8. DOI: 10.1016/j.ijrobp.2009.01.041.Jagsi R., Ben-David M.A. Unacceptable cosmesis in a protocol investigating intensity-modulated radiotherapy with active breathing control for accelerated partial-breast irradiation. J Radiat Oncol Biol Phys 2010;76(1):71–8. DOI: 10.1016/j.ijrobp.2009.01.041.17. Neumaier C., Elena S., Grit W. TARGIT-E (еlderly) – prospective phase II study of intraoperative radiotherapy (IORT) in elderly patients with small breast cancer. BMC Cancer 2012;12:171. DOI: 10.1186/1471-2407-12-171.Neumaier C., Elena S., Grit W. TARGIT-E (еlderly) – prospective phase II study of intraoperative radiotherapy (IORT) in elderly patients with small breast cancer. BMC Cancer 2012;12:171. DOI: 10.1186/1471-2407-12-171.18. Polgár C., Van Limbergen E., Pötter R. GEC-ESTRO breast cancer working group. Patient selection for accelerated partial-breast irradiation (APBI) after breastconserving surgery: recommendations of the Groupe Européen de Curiethérapie-European Society for Therapeutic Radiology and Oncology (GEC-ESTRO) breast cancer working group based on clinical evidence (2009). Radiother Oncol 2010;94(3): 264–73. DOI: 10.1016/j.radonc.2010.01.014.Polgár C., Van Limbergen E., Pötter R. GEC-ESTRO breast cancer working group. Patient selection for accelerated partial-breast irradiation (APBI) after breastconserving surgery: recommendations of the Groupe Européen de Curiethérapie-European Society for Therapeutic Radiology and Oncology (GEC-ESTRO) breast cancer working group based on clinical evidence (2009). Radiother Oncol 2010;94(3): 264–73. DOI: 10.1016/j.radonc.2010.01.014.19. Smith B.D., Arthur D.W., Buchholz Th. et al. Accelerated partial breast irradiation consensus statement from the American Society for Radiation Oncology (ASTRO). J Am Coll Surg 2009;209(2):269–77. DOI: 10.1016/j.jamcollsurg.2009.02.066.Smith B.D., Arthur D.W., Buchholz Th. et al. Accelerated partial breast irradiation consensus statement from the American Society for Radiation Oncology (ASTRO). J Am Coll Surg 2009;209(2):269–77. DOI: 10.1016/j.jamcollsurg.2009.02.066.20. Stroom J., Shilief A. Using histopathology breast cancer data to reduce clinical target volume margins at radiotherapy. Int J Rad Oncol Biol Phys 2009;74(3):898–905. DOI: 10.1016/j.ijrobp.2009.01.026.Stroom J., Shilief A. Using histopathology breast cancer data to reduce clinical target volume margins at radiotherapy. Int J Rad Oncol Biol Phys 2009;74(3):898–905. DOI: 10.1016/j.ijrobp.2009.01.026.21. Kirby A.M., Coles Ch.E., Yarnold J.R. Target volume definition for external beam partial breast radiotherapy: clinical, pathological and technical studies informing current approaches. Radiother Oncol 2010;94(3):255–63. DOI: 10.1016/j.radonc.2009.12.010.Kirby A.M., Coles Ch.E., Yarnold J.R. Target volume definition for external beam partial breast radiotherapy: clinical, pathological and technical studies informing current approaches. Radiother Oncol 2010;94(3):255–63. DOI: 10.1016/j.radonc.2009.12.010.22. Edge S.B., Byrd D.R., Compton C.C. American Joint Committee on Cancer. AJCC Cancer staging manual. 7th edn. New York: Springer-Verlag, 2010. 646 p.Edge S.B., Byrd D.R., Compton C.C. American Joint Committee on Cancer. AJCC Cancer staging manual. 7th edn. New York: Springer-Verlag, 2010. 646 p.23. Wobb J., Wilkinson J.B., Shah C. et al. Impact of the number of cautionary and/or unsuitable risk factors on outcomes after accelerated partial breast irradiation. Int J Radiat Oncol Biol Phys 2013;87(1):134–8. DOI: 10.1016/j.ijrobp.2013.05.030.Wobb J., Wilkinson J.B., Shah C. et al. Impact of the number of cautionary and/or unsuitable risk factors on outcomes after accelerated partial breast irradiation. Int J Radiat Oncol Biol Phys 2013;87(1):134–8. DOI: 10.1016/j.ijrobp.2013.05.030.24. Polgár C., Ott O.J., Hildebrandt G. Late side-effects and cosmetic results of accelerated partial breast irradiation with interstitial brachytherapy versus whole-breast irradiation after breast-conserving surgery for low-risk invasive and in situ carcinoma of the female breast: 5-year results of a randomised, controlled, phase 3 trial. Lancet Oncol 2017;18(2):259–68. DOI: 10.1016/S1470-2045(17)30011-6.Polgár C., Ott O.J., Hildebrandt G. Late side-effects and cosmetic results of accelerated partial breast irradiation with interstitial brachytherapy versus whole-breast irradiation after breast-conserving surgery for low-risk invasive and in situ carcinoma of the female breast: 5-year results of a randomised, controlled, phase 3 trial. Lancet Oncol 2017;18(2):259–68. DOI: 10.1016/S1470-2045(17)30011-6.25. Veronesi U., Orecchia R., Maisonneuve P. Intraoperative radiotherapy versus external radiotherapy for early breast cancer(ELIOT): a randomized controlled equivalence trial. Lancet Oncol 2013;14(13):1269–77. DOI: 10.1016/S1470-2045(13)70497-2.Veronesi U., Orecchia R., Maisonneuve P. Intraoperative radiotherapy versus external radiotherapy for early breast cancer(ELIOT): a randomized controlled equivalence trial. Lancet Oncol 2013;14(13):1269–77. DOI: 10.1016/S1470-2045(13)70497-2.26. Bentzen S.M., Yarnold J. Reports of unexpected late side-effects of accelerated partial breast irradiation – radiobiological considerations. Int J Radiat Oncol Biol Phys;77(4):969–73. DOI: 10.1016/j.ijrobp.2010.01.059.Bentzen S.M., Yarnold J. Reports of unexpected late side-effects of accelerated partial breast irradiation – radiobiological considerations. Int J Radiat Oncol Biol Phys;77(4):969–73. DOI: 10.1016/j.ijrobp.2010.01.059.27. Cox J.D., Stetz J., Pajak T.F. Toxicity criteria of the Radiation Therapy Oncology Group (RTOG) and the European Organization for Research and Treatment of Cancer (EORTC). Int J Radiat Oncol Biol Phys 1995;31(5): 1341–6. DOI: 10.1016/0360-3016(95)00060-C.Cox J.D., Stetz J., Pajak T.F. Toxicity criteria of the Radiation Therapy Oncology Group (RTOG) and the European Organization for Research and Treatment of Cancer (EORTC). Int J Radiat Oncol Biol Phys 1995;31(5): 1341–6. DOI: 10.1016/0360-3016(95)00060-C.