Akutna kožna toksičnost kod pacijentkinja sa karcinomom dojke nakon različitih režima frakcionisanja postoperativne radioterapije
Ključne reči:
rak dojke, poštedna operacija dojke, radioterapija, radiodermatitis
Sažetak
Uvod/Cilj: Karcinom dojke (BC) predstavlja globalno značajan zdravstveni problem, sa incidencijom koja varira širom sveta. Savremeni terapijski protokoli uključuju multidisciplinarni pristup koji kombinuje hirurgiju, hemoterapiju, hormonoterapiju, ciljanu terapiju i radioterapiju. Radioterapija je ključna u tretmanu BC, ali može izazvati akutne neželjene efekte, uključujući kožne reakcije. Cilj ovog istraživanja bio je da se proceni uticaj dva različita režima frakcionisanja radioterapije na pojavu i težinu akutne kožne toksičnosti kod pacijentkinja sa karcinomom dojke.
Pacijenti i metode: . Studija je obuhvatila 44 pacijentkinje koje su podvrgnute postoperativnoj radioterapiji. Pacijentkinje su bile nasumično raspoređene u dve grupe: jedna grupa je tretirana hipofrakcionisanim režimom (40,05 Gy u 15 frakcija tokom tri nedelje), dok je druga grupa primala standardni frakcionisani režim (50 Gy u 25 frakcija tokom pet nedelja).Pacijentkinje su bile podvrgnute nedeljnim procenama akutne kožne toksičnosti tokom trajanja tretmana.
Rezultati: Rezultati istraživanja pokazali su da su pacijentkinje koje su primale standardni frakcionisani režim imale veću učestalost i intenzitet akutnih kožnih reakcija, uključujući eritem, suvu deskvamaciju i vlažnu deskvamaciju. Posebno su izražene bile reakcije kože gradusa I i II kod pacijentkinja u grupi koja je primala 50 Gy. Iako su pacijentkinje koje su primale hipofrakcionisanu radioterapiju imale manje ozbiljne kožne reakcije, pojavile su se blage kožne promene koje su generalno bile manje izražene.
Zaključak: Studija ukazuje na potrebu za pažljivim odabirom režima frakcionisanja u postoperativnoj radioterapiji dojke. Takođe, doprinosi razumevanju odnosa između različitih radioterapijskih modaliteta i pojave akutne kožne toksičnosti, pružajući smernice za optimizaciju tretmana kod pacijentkinja sa karcinomom dojke.
Reference
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26.Lee J, Park W, Choi DH, et al. Patient-reported symptoms of radiation dermatitis during breast cancer radiotherapy: a pilot study. Qual Life Res. 2017;26:1713–1719.
27.Owen JR, Ashton A, Bliss JM, et al. Effect of radiotherapy fraction size on tumour control in patients with early-stage breast cancer after local tumour excision: long-term results of a randomised trial. Lancet Oncol. 2006 Jun;7(6):467-71. doi: 10.1016/S1470-2045(06)70699-4. Erratum in: Lancet Oncol. 2006 Aug;7(8):620.
28.Pires AMT, Segreto RA, Segreto HRC. RTOG criteria to evaluate acute skin reaction and its risk factors in patients with breast cancer submitted to radiotherapy. Rev Lat Am Enfermagem. 2008;16:844–849.
29.Xiao C, Miller AH, Felger J, et al. A prospective study of quality of life in breast cancer patients undergoing radiation therapy. Adv Radiat Oncol. 2016 Jan-Mar;1(1):10-16.
30.Whelan TJ, Olivotto IA, Parulekar WR, et al. Study Investigators. Regional Nodal Irradiation in Early-Stage Breast Cancer. N Engl J Med. 2015 Jul 23;373(4):307-16.
31.Lee SY, Kwon HC, Kim JS, et al. An Analysis of the Incidence and Related Factors for Radiation Dermatitis in Breast Cancer Patients Who Received Radiation Therapy. J Korean Soc Ther Radiol Oncol. 2010;28(1):16-22.
32.De Ruysscher D, Niedermann G, Burnet NG, et al. Radiotherapy toxicity. Nat Rev Dis Primers. 2019 Feb 21;5(1):13. doi: 10.1038/s41572-019-0064-5. Erratum in: Nat Rev Dis Primers. 2019 Mar 4;5(1):15.
33.Shaitelman S, Schlembach PJ, Arzu I, et al. Acute and short-term toxic effects of conventionally fractionated vs hypofractionated whole-breast irradiation: A randomized clinical trial. JAMA Oncol 1, 931–41 (2015).
34.Jagsi R, Griffith KA, Boike TP, et al. Differences in the Acute Toxic Effects of Breast Radiotherapy by Fractionation Schedule: Comparative Analysis of Physician-Assessed and Patient-Reported Outcomes in a Large Multicenter Cohort. JAMA Oncol (2015) 1(7):918–30.
35.Haviland JS, Owen JR, Dewar JA, et al. The UK Standardisation of Breast Radiotherapy (START) trials of radiotherapy hypofractionation for treatment of early breast cancer: 10-year follow-up results of two randomised controlled trials. Lancet Oncol 2013;14:1086–1094.
36.Bekelman JE, Sylwestrzak G, Barron J, et al. Uptake and F. costs of hypofractionated vs conventional whole breast irradiation after breast conserving surgery in the United States, 2008-2013. JAMA 2014;312:2542–2550.
2.Sung H, Ferlay J, Siegel RL, et al. Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA Cancer J Clin. 2021 May;71(3):209-249.
3.Bray F, Ferlay J, Soerjomataram I, et al. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2018 Nov;68(6):394-424.
4.Iw Fackenthal JD, Olopade OI. Breast cancer risk associated with BRCA1 and BRCA2 in diverse populations. Nat Rev Cancer. 2007 Dec;7(12):937-48.
5.Iwamoto Y, Kaucher S, Lorenz E, et al. Development of breast cancer mortality considering the implementation of mammography screening programs - a comparison of western European countries. BMC Public Health. 2019 Jun;19((1)):823.
6.Shah C, Al-Hilli Z, Vicini F. Advances in Breast Cancer Radiotherapy: Implications for Current and Future Practice. JCO Oncol Pract. 2021 Dec;17(12):697-706.
7.Sjövall K, Strömbeck G, Löfgren A, et al. Adjuvant radiotherapy of women with breast cancer - information, support and side-effects. Eur J Oncol Nurs. 2010 Apr;14(2):147-53.
8.Sekiguchi K, Ogita M, Akahane K, et al. Randomized, prospective assessment of moisturizer efficacy for the treatment of radiation dermatitis following radiotherapy after breast-conserving surgery. Jpn J Clin Oncol. 2015 Dec;45(12):1146-53.
9.Seité S, Bensadoun RJ, Mazer JM. Prevention and treatment of acute and chronic radiodermatitis. Breast Cancer (Dove Med Press). 2017 Nov 2;9:551-557.
10.Bolderston A, Lloyd NS, Wong RK, et al. Supportive Care Guidelines Group of Cancer Care Ontario Program in Evidence-Based Care. The prevention and management of acute skin reactions related to radiation therapy: a systematic review and practice guideline. Support Care Cancer. 2006 Aug;14(8):802-17.
11.Thames HD, Bentzen SM, Turesson I, et al. Time-dose factors in radiotherapy: a review of the human data. Radiother Oncol. 1990 Nov;19(3):219-35.
12. Batumalai V, Delaney GP, Descallar J, et al. Variation in the use of radiotherapy fractionation for breast cancer: survival outcome and cost implications. Radiother Oncol. 2020;152:70–77.
13.Tortorelli G, Di Murro L, Barbarino R, et al. Standard or hypofractionated radiotherapy in the postoperative treatment of breast cancer: a retrospective analysis of acute skin toxicity and dose inhomogeneities. BMC Cancer. 2013 May 7;13:230.
14.Pires AM, Segreto RA, Segreto HR. RTOG criteria to evaluate acute skin reaction and its risk factors in patients with breast cancer submitted to radiotherapy. Rev Lat Am Enfermagem. 2008 Sep-Oct;16(5):844-9.
15.Veronesi, N. Cascinelli, L. Mariani et al. Twenty-year follow-up of a randomized study comparing breast-conserving surgery with radical mastectomy for early breast cancer. New England Journal of Medicine, 2002: 347,16:1227–1232.
16.Corradini S, Reitz D, Pazos M, et al. Mastectomy or Breast-Conserving Therapy for Early Breast Cancer in Real-Life Clinical Practice: Outcome Comparison of 7565 Cases. Cancers (Basel). 2019 Jan 31;11(2):160.
17.SK Al-Ghazal, L Fallowfield, RW Blamey. Does cosmetic outcome from treatment of primary breast cancer influence psychosocial morbidity. European Journal of Surgical Oncology. 1999;25(6):571–573.
18.Agarwal S, Pappas L, Neumayer L, et al. Effect of breast conservation therapy vs mastectomy on disease-specific survival for early-stage breast cancer. JAMA Surg. 2014;149:267–274.
19.Van Maaren MC, de Munck L, de Bock GH, et al. 10 year survival after breast-conserving surgery plus radiotherapy compared with mastectomy in early breast cancer in the Netherlands: A population-based study. Lancet Oncol. 2016;17:1158–1170.
20.Early Breast Cancer Trialists’ Collaborative Group, 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 randomised trials. Lancet. 2011;378:1707–1716.
21.Duma, MN, Baumann R, Budach W, et al. Heartsparing radiotherapy techniques in breast cancer patients: A recommendation of the breast cancer expert panel of the German society of radiation oncology (DEGRO). Strahlenther Onkol. 2019, 195, 861–871.
22.Whelan TJ, Pignol JP, Levine MN, et al. Long-term results of hypofractionated radiation therapy for breast cancer. N Engl J Med 2010;362:513–520.
23.EBCTCG (Early Breast Cancer Trialists' Collaborative Group), McGale P, Taylor C, et al. Effect of radiotherapy after mastectomy and axillary surgery on 10-year recurrence and 20-year breast cancer mortality: meta-analysis of individual patient data for 8135 women in 22 randomised trials. Lancet. 2014 Jun 21;383(9935):2127-35.
24.Abadir R, Liebmann J. Radiation reaction recall following simvastatin therapy: a new observation. Clin Oncol. 1995;7:325–326.
25.Slamon D, Eiermann W, Robert N, et al. Adjuvant Trastuzumab in HER2-Positive Breast Cancer. N. Engl. J. Med. 2011;365:1273–1283.
26.Lee J, Park W, Choi DH, et al. Patient-reported symptoms of radiation dermatitis during breast cancer radiotherapy: a pilot study. Qual Life Res. 2017;26:1713–1719.
27.Owen JR, Ashton A, Bliss JM, et al. Effect of radiotherapy fraction size on tumour control in patients with early-stage breast cancer after local tumour excision: long-term results of a randomised trial. Lancet Oncol. 2006 Jun;7(6):467-71. doi: 10.1016/S1470-2045(06)70699-4. Erratum in: Lancet Oncol. 2006 Aug;7(8):620.
28.Pires AMT, Segreto RA, Segreto HRC. RTOG criteria to evaluate acute skin reaction and its risk factors in patients with breast cancer submitted to radiotherapy. Rev Lat Am Enfermagem. 2008;16:844–849.
29.Xiao C, Miller AH, Felger J, et al. A prospective study of quality of life in breast cancer patients undergoing radiation therapy. Adv Radiat Oncol. 2016 Jan-Mar;1(1):10-16.
30.Whelan TJ, Olivotto IA, Parulekar WR, et al. Study Investigators. Regional Nodal Irradiation in Early-Stage Breast Cancer. N Engl J Med. 2015 Jul 23;373(4):307-16.
31.Lee SY, Kwon HC, Kim JS, et al. An Analysis of the Incidence and Related Factors for Radiation Dermatitis in Breast Cancer Patients Who Received Radiation Therapy. J Korean Soc Ther Radiol Oncol. 2010;28(1):16-22.
32.De Ruysscher D, Niedermann G, Burnet NG, et al. Radiotherapy toxicity. Nat Rev Dis Primers. 2019 Feb 21;5(1):13. doi: 10.1038/s41572-019-0064-5. Erratum in: Nat Rev Dis Primers. 2019 Mar 4;5(1):15.
33.Shaitelman S, Schlembach PJ, Arzu I, et al. Acute and short-term toxic effects of conventionally fractionated vs hypofractionated whole-breast irradiation: A randomized clinical trial. JAMA Oncol 1, 931–41 (2015).
34.Jagsi R, Griffith KA, Boike TP, et al. Differences in the Acute Toxic Effects of Breast Radiotherapy by Fractionation Schedule: Comparative Analysis of Physician-Assessed and Patient-Reported Outcomes in a Large Multicenter Cohort. JAMA Oncol (2015) 1(7):918–30.
35.Haviland JS, Owen JR, Dewar JA, et al. The UK Standardisation of Breast Radiotherapy (START) trials of radiotherapy hypofractionation for treatment of early breast cancer: 10-year follow-up results of two randomised controlled trials. Lancet Oncol 2013;14:1086–1094.
36.Bekelman JE, Sylwestrzak G, Barron J, et al. Uptake and F. costs of hypofractionated vs conventional whole breast irradiation after breast conserving surgery in the United States, 2008-2013. JAMA 2014;312:2542–2550.
Objavljeno
2025/11/19
Broj časopisa
Rubrika
Originalni rad / Original article