RESUMEN
PURPOSE: To report 3-year toxicity, cosmesis, and efficacy of a multicenter study of external beam, accelerated partial breast irradiation (APBI) for early-stage breast cancer. METHODS AND MATERIALS: Between March 2005 and August 2006, 127 women aged ≥40 years with ductal carcinoma in situ or node-negative invasive breast cancer ≤3 cm in diameter, treated with breast-conserving surgery achieving negative margins, were accrued to a prospective study involving five Canadian cancer centers. Women meeting predefined dose constraints were treated with APBI using 3 to 5 photon beams, delivering 35 to 38.5 Gy in 10 fractions, twice a day, over 1 week. Patients were assessed for treatment-related toxicities, cosmesis, and efficacy before APBI and at specified time points for as long as 3 years after APBI. RESULTS: 104 women had planning computed tomography scans showing visible seromas, met dosimetric constraints, and were treated with APBI to doses of 35 Gy (n=9), 36 Gy (n=33), or 38.5 Gy (n=62). Eighty-seven patients were evaluated with minimum 3-year follow-up after APBI. Radiation dermatitis, breast edema, breast induration, and fatigue decreased from baseline levels or stabilized by the 3-year follow-up. Hypopigmentation, hyperpigmentation, breast pain, and telangiectasia slightly increased from baseline levels. Most toxicities at 3 years were Grade 1. Only 1 patient had a Grade 3 toxicity with telangiectasia in a skin fold inside the 95% isodose. Cosmesis was good to excellent in 86% (89/104) of women at baseline and 82% (70/85) at 3 years. The 3-year disease-free survival was 97%, with only one local recurrence that occurred in a different quadrant away from the treated site and two distant recurrences. CONCLUSIONS: At 3 years, toxicity and cosmesis were acceptable, and local control and disease-free survival were excellent, supporting continued accrual to randomized APBI trials.
Asunto(s)
Neoplasias de la Mama/radioterapia , Carcinoma Ductal de Mama/radioterapia , Carcinoma Intraductal no Infiltrante/radioterapia , Radioterapia Conformacional/métodos , Adulto , Anciano , Anciano de 80 o más Años , Neoplasias de la Mama/patología , Neoplasias de la Mama/cirugía , Canadá , Carcinoma Ductal de Mama/patología , Carcinoma Ductal de Mama/cirugía , Carcinoma Intraductal no Infiltrante/patología , Carcinoma Intraductal no Infiltrante/cirugía , Supervivencia sin Enfermedad , Fraccionamiento de la Dosis de Radiación , Estudios de Factibilidad , Femenino , Humanos , Mastectomía Segmentaria , Persona de Mediana Edad , Fotones/uso terapéutico , Estudios Prospectivos , Traumatismos por Radiación/patología , Radiografía , Radioterapia Conformacional/efectos adversos , Seroma/diagnóstico por imagen , Factores de Tiempo , Resultado del Tratamiento , Carga TumoralRESUMEN
OBJECTIVE: In patients with hematologic malignancies, chemotherapy can further suppress bone marrow production. Whereas measures to correct anemia can improve patients' function and quality of life, the intervention threshold and the methods of correcting anemia in patients with malignant lymphoma are not clear. This study evaluates the frequency of anemia and the interventions used to correct anemia before and during chemotherapy for patients with Hodgkin and non-Hodgkin lymphomas. METHODS: A retrospective electronic chart review was conducted of 312 patients who received cytotoxic chemotherapy for malignant lymphoma at 4 British Columbia Cancer Agency centers from June 1, 2004 to May 1, 2006. The chemotherapy regimens delivered were: doxorubicin, cyclophosphamide, vincristine, and prednisone (CHOP) in 24 patients, CHOP + Rituximab (CHOP-R) in 215 patients, and Adriamycin, bleomycin, vinblastine, dacarbazine in 73 patients. Initial hemoglobin (Hgb) and dates of lowest Hgb in the ranges, 110 to 119, 100 to 109, 90 to 99, 80 to 89, and <80 g/L were recorded. Review of medical records was performed to document the frequency of symptoms that may be related to anemia and the frequency of any discussion or intervention for anemia such as transfusion or erythropoietin (Epo). RESULTS: The median age was 57 years (range, 16-87 years). About 24% of patients had Hodgkin's and 76% had non-Hodgkin's lymphoma. Prior to starting chemotherapy, 34% of subjects had an Hgb <120 g/L and 11% of subjects had an Hgb <100 g/L. In all patients with Hgb <120 g/L prechemotherapy, symptoms of anemia were documented in 57% but intervention to correct anemia occurred in only 4% of patients. During chemotherapy, 42% of subjects had a Hgb <120 g/L and 12% had a Hgb <100 g/L. Discussion and intervention rates increased with declining Hgb, particularly at levels <100 g/L. Among 36 patients with Hgb <100 g/L, symptoms were documented in 31 patients. Transfusion was used in 24 patients and Epo in 2 patients. During chemotherapy, 63% of patients with Hgb <120 g/L were symptomatic, but only 20% received an intervention to correct anemia. CONCLUSION: Anemia was common prior to and during chemotherapy in patients with malignant lymphoma. The threshold of anemia intervention varied, with transfusion being the predominant method used. The rates of intervention for anemia were low in patients with anemia, despite randomized trials showing that anemia correction can improve fatigue and quality of life.