Luisa E Jacomina, David M Swanson, Melissa P Mitchell, Wendy A Woodward, Benjamin D Smith, Karen E Hoffman, Chelain R Goodman, Haven R Garber, Susie X Sun, Timothy A Yap, Funda Meric-Bernstam, Isidora Y Arzu, Elizabeth S Bloom, Pamela J Schlembach, Eric A Strom, Michael C Stauder, Simona F Shaitelman
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Although palliative radiotherapy (RT) can minimize tumor-related symptoms, how best to tailor RT to achieve the most meaningful and durable response is not well defined.</p><p><strong>Methods: </strong>This is a single-institution, multi-site retrospective review of patients with SLABC treated between 2016 and 2023 with palliative RT to symptomatic disease in the breast, chest wall, and/or regional lymph node basins. Overall survival (OS), locoregional control (LC), clinical and radiographic treatment response, overall pain scores, and treatment-related toxicities were analyzed.</p><p><strong>Results: </strong>164 patients with a median age of 57 years were analyzed with a median follow-up time of 4.97 months. 86% had distant metastases. The most common presenting symptom was pain (87%), followed by ulcerating or fungating lesion (76%) and discharge (45%). The median cumulative biologically effective dose to the gross tumor volume (BED<sub>GTV</sub>) was 69 Gy. The 1-year OS and LC rates were 37% and 63%, respectively. Eighty-one percent experienced improvement in symptoms within 3 months after RT, the odds of which increased per Gy BED<sub>GTV</sub> (OR 1.029, p=0.003). Acute toxicities were associated with number of fractions and BED<sub>GTV</sub> (both p<.001), but not with concurrent systemic therapy nor reirradiation (both p>.05). Trends in pain scores showed a significant change in pain trajectory that was sustained during the first year after RT. OS and LC were not different among patients who received 1 vs 2-10 vs >10 fractions, and between ≤70 vs >70 Gy BED<sub>GTV</sub>.</p><p><strong>Conclusion: </strong>In this large series of patients with SLABC, palliative RT was effective at relieving locoregional symptoms with acceptable toxicity, with the likelihood of symptom improvement associated with radiation dose. 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引用次数: 0
摘要
背景：有症状的局部区域性晚期乳腺癌（SLABC）可引起令人烦恼的疼痛或伤口并发症，对生活质量产生负面影响。虽然姑息性放疗（RT）可以最大限度地减轻肿瘤相关症状，但如何更好地调整RT以获得最有意义和最持久的反应，目前还没有明确的定义：这是对2016年至2023年间接受姑息性RT治疗的乳腺、胸壁和/或区域淋巴结盆腔无症状疾病的SLABC患者进行的单机构、多地点回顾性研究。对患者的总生存期（OS）、局部区域控制（LC）、临床和放射学治疗反应、总体疼痛评分以及治疗相关毒性反应进行了分析：分析了 164 名患者，中位年龄为 57 岁，中位随访时间为 4.97 个月。86%的患者有远处转移。最常见的症状是疼痛（87%），其次是溃疡或发霉病变（76%）和分泌物（45%）。肿瘤总体积累积生物有效剂量（BEDGTV）的中位数为69 Gy。1年的OS和LC率分别为37%和63%。81%的患者在 RT 术后 3 个月内症状有所改善，BEDGTV 每增加 1 Gy，症状改善的几率增加（OR 1.029，P=0.003）。急性毒性与分次数和 BEDGTV 相关（均为 p.05）。疼痛评分趋势显示，疼痛轨迹发生了显著变化，这种变化在 RT 术后第一年持续存在。接受1 vs 2-10 vs >10次分次治疗的患者之间，以及接受≤70 vs >70 Gy BEDGTV治疗的患者之间，OS和LC没有差异：结论：在这一大型SLABC患者系列中，姑息性RT能有效缓解局部症状，且毒性可接受，症状改善的可能性与放射剂量有关。这些患者的存活率仍然很低，这凸显了姑息治疗策略的重要性，它能最大限度地减轻总体症状负担，同时最大限度地提高生活质量。
Outcomes After Palliative Radiotherapy in Patients with Symptomatic Locoregionally Advanced Breast Cancer.
Background: Symptomatic locoregionally advanced breast cancer (SLABC) can cause troublesome pain or wound complications that negatively impact quality of life. Although palliative radiotherapy (RT) can minimize tumor-related symptoms, how best to tailor RT to achieve the most meaningful and durable response is not well defined.
Methods: This is a single-institution, multi-site retrospective review of patients with SLABC treated between 2016 and 2023 with palliative RT to symptomatic disease in the breast, chest wall, and/or regional lymph node basins. Overall survival (OS), locoregional control (LC), clinical and radiographic treatment response, overall pain scores, and treatment-related toxicities were analyzed.
Results: 164 patients with a median age of 57 years were analyzed with a median follow-up time of 4.97 months. 86% had distant metastases. The most common presenting symptom was pain (87%), followed by ulcerating or fungating lesion (76%) and discharge (45%). The median cumulative biologically effective dose to the gross tumor volume (BEDGTV) was 69 Gy. The 1-year OS and LC rates were 37% and 63%, respectively. Eighty-one percent experienced improvement in symptoms within 3 months after RT, the odds of which increased per Gy BEDGTV (OR 1.029, p=0.003). Acute toxicities were associated with number of fractions and BEDGTV (both p<.001), but not with concurrent systemic therapy nor reirradiation (both p>.05). Trends in pain scores showed a significant change in pain trajectory that was sustained during the first year after RT. OS and LC were not different among patients who received 1 vs 2-10 vs >10 fractions, and between ≤70 vs >70 Gy BEDGTV.
Conclusion: In this large series of patients with SLABC, palliative RT was effective at relieving locoregional symptoms with acceptable toxicity, with the likelihood of symptom improvement associated with radiation dose. Survival of these patients remains poor, highlighting the importance of palliative care strategies that minimize overall symptom burden while maximizing quality of life.
期刊介绍：
International Journal of Radiation Oncology • Biology • Physics (IJROBP), known in the field as the Red Journal, publishes original laboratory and clinical investigations related to radiation oncology, radiation biology, medical physics, and both education and health policy as it relates to the field.
This journal has a particular interest in original contributions of the following types: prospective clinical trials, outcomes research, and large database interrogation. In addition, it seeks reports of high-impact innovations in single or combined modality treatment, tumor sensitization, normal tissue protection (including both precision avoidance and pharmacologic means), brachytherapy, particle irradiation, and cancer imaging. Technical advances related to dosimetry and conformal radiation treatment planning are of interest, as are basic science studies investigating tumor physiology and the molecular biology underlying cancer and normal tissue radiation response.
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