2022 ESTRO共识建议早期乳腺癌体外放疗的患者选择、剂量和分割.ppt

START-A,moderateormarkedbreastinduration,telangiectasia,andbreastoedemaweresignificantlylesscommonnormaltissueeffectsinthe39Gygroupthaninthe50Gygroup.Normaltissueeffectsdidnotdiffersignificantlybetween41·6Gyand50Gygroups.START-B,breastshrinkage,telangiectasia,andbreastoedemaweresignificantlylesscommonnormaltissueeffectsinthe40Gygroupthaninthe50Gygroup.InterpretationLong-termfollow-upconfirmsthatappropriatelydosedhypofractionatedradiotherapyissafeandeffectiveforpatientswithearlybreastcancer.Theresultssupportthecontinueduseof40Gyin15fractions,whichhasalreadybeenadoptedbymostUKcentresasthestandardofcareforwomenrequiringadjuvantradiotherapyforinvasiveearlybreastcancer在START试验中，采用中度低分割的少数患者（15%）接受淋巴结照射。无论是在癌症控制还是正常组织效应方面，都没有安全问题在5分次，27Gy的正常组织结果中，肿瘤床外的乳腺硬化是唯一具有统计学意义（p0.0001）的更差疗效。然而，该终点的临床意义仍有争议，观察到的5年中度或显著事件发生率在26Gy组仅为1.9%，在40Gy组为0.1%。由于数据尚未成熟（预计2022年），FASTForward主要试验队列中未包括淋巴结照射，FASTForward淋巴结亚研究也未报告。因此，五分次淋巴结放射治疗尚不能视为当前的治疗标准。11ipsilateralbreastcancerevents(50Gy:3;30Gy:4;28.5Gy:4)and96deaths(50Gy:30;30Gy:33;28.5Gy:33)haveoccurred.入组标准Women≥50yearsofagelow-riskinvasivebreastcarcinoma(pT1-2pN0)50Gy/25fr(5weeks)30or28.5Gyin5once-weeklyfrof6.0or5.7Gy主要终点：changeinphotographicbreastappearanceat2and5years次要终点：physicianassessmentsofNTEandlocaltumorcontrol，Oddsratios(ORs)fromlongitudinalanalysescomparedregimensORsforchangeinphotographicbreastappearancewere1.64(95%CI,1.08to2.49;P=.019)for30Gyand1.10(95%CI,0.70to1.71;P=.686)for28.5Gyversus50Gy.11ipsilateralbreastcancerevents(50Gy:3;30Gy:4;28.5Gy:4)and96deaths(50Gy:30;30Gy:33;28.5Gy:33)haveoccurred.Physicianassessmentsoflatenormaltissueeffects.Breastshrinkageto10years;timetofirstreportedmoderate/markedbreastshrinkageNTEwereh