COVID-19 Pandemisi Sırasında Hipofraksiyone Meme Kanseri Işınlaması ve Erken Sonuçları; Tek Merkez Deneyimi

Öz

Amaç: COVID-19 pandemisi sırasında meme radyoterapisi uygulanan hastalarda hipofraksiyone radyoterapinin dozimetrik olarak analizi ve erken klinik sonuçlarının değerlendirilmesi amaçlanmıştır.

Materyal ve Metot: Meme kanseri nedeniyle radyoterapi alan on yedi kadın hasta çalışmaya dahil edilmiştir. Hedef hacme 42,55 Gray (Gy) tedavi dozu tanımlanarak, toplamda 16 fraksiyonda uygulandı. Hastaların COVID-19 belirtileri ve akut yan etkileri takip edilmiştir.

Bulgular: On yedi meme kanseri hastasına hipofraksiyone radyoterapi uygulanmıştır. Hedef volümlerin % 95’inin aldığı doz ve kritik organların dozları 25 fraksiyonda 50 Gy Radyoterapi tedavi dozuna normalize edilerek değerlendirilmiştir. Tüm planlar 50 Gy’ lik tedavi dozuna normalize edildikten sonra medulla spinalisin maksimum dozunun <45 Gy ve Kalp için ortalama dozun <5 Gy olması sağlanmıştır. Akciğer için 20 Gy veya daha fazlasını alan akciğer hacmi ortalama 20,19 Gy olarak elde edilmiştir. Ortalama 5 aylık takip süresince sadece 5 hastada grad 1 cilt reaksiyonu görülmüştür.

Sonuç: Meme kanseri tedavisinde hipo-fraksiyonasyone radyoterapi, pandemi döneminde hastaların tedavi sürelerinin kısaltılması ve daha az riske maruz kalınılması açısından daha uygundur. Aynı zamanda, tedavi süresi kısaldığı için de tedavi maliyeti daha düşük olmaktadır. 

Anahtar Kelimeler

• COVID-19
• hipofraksiyone
• meme kanseri
• radyoterapi

Hypofractionated Breast Cancer Irradiation and Early Results During the COVID-19 Pandemic; Single Center Experience

Abstract

Objective: We aimed to the dosimetric analysis of hypofractionated radiation therapy and early clinical results of patients who received breast radiation therapy during the COVID 19 pandemic.

Materials and Methods: Seventeen women who received breast cancer radiotherapy were included in the study. For target volumes, the prescription dose was applied 42.55 Gray (Gy) in 16 fractions. COVID-19 symptoms and acute side effects of the patients were followed.

Results: Seventeen breast cancer patients were treated with hypofractionated radiotherapy. Dose of 95% of target volumes and critical organ doses were evaluated by normalizing to 50 Gy in 25 fractions. When all plans were evaluated by normalizing to 50 Gy, the maximum dose of medulla spinalis was <45 Gy. The mean dose of heart was <5 Gy. The volume for the lung receiving 20 Gy or more was averaged 20.19. Grade 1 skin reaction was observed in only 5 patients during a mean follow-up of 5 months.

Conclusion: In the treatment of breast cancer, hypofractionated radiotherapy is more suitable in terms of shortening the treatment period of patients in the pandemic period and being exposed to less risk. At the same time, the treatment cost is lower as the treatment time is shortened. 

Keywords

• COVID-19
• breast cancer
• hypo-fractionate
• radiotherapy

References

1. Early Breast Cancer Trialists' Collaborative Group (EBCTCG), Darby S, McGale P, 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):1707-1716. doi:10.1016/S0140-6736(11)61629-2
2. FAST Trialists group, Agrawal RK, Alhasso A, et al. First results of the randomized UK FAST Trial of radiotherapy hypofractionation for treatment of early breast cancer (CRUKE/04/015). Radiother Oncol. 2011;100(1):93-100. doi:10.1016/j.radonc.2011.06.026
3. Whelan T, MacKenzie R, Julian J et al. Long-term results of hypofractionated radiation therapy for breast cancer. N Engl J Med. 2010;362(6):513-520. doi:10.1056/NEJMoa0906260
4. Haviland J, Owen J, Dewar J, et al. The UK Standardization of Breast Radiotherapy (START) trials of radiotherapy hypofractionation for treatment of early breast cancer: 10-year follow-up results of two randomized controlled trials. Lancet Oncol. 2013;14(11):1086-1094. doi:10.1016/S1470-2045 (13)70386-3
5. Mullieza T, Veldeman L, Greveling A et al. Hypofractionated whole breast irradiation for patients with large breasts: a randomized trial comparing prone and supine positions. Radiother Oncol. 2013;108(2):203-208. doi:10.1016/j.radonc.2013.08.040
6. 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):1707-1716. doi:10.1016/S0140-6736(11)61629-2
7. McGale P, Taylor C, Correa 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;383(9935):2127-2135. doi:10.1016/S0140-6736(14)60488-8
8. Yarnold J, Ashton A, Bliss J, et al. Fractionation sensitivity and dose response of late adverse effects in the breast after radiotherapy for early breast cancer: long-term results of a randomised trial. Radiother Oncol. 2005;75(1):9-17. doi:10.1016/j.radonc.2005.01.005

9. 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;7(6):467-471. doi:10.1016/S1470-2045(06)70699-4
10. 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. doi:10.1056/NEJMoa0906260
11. Gupta A, Ohri N, Haffty BG. Hypofractionated radiation treatment in the management of breast cancer. Expert Rev Anticancer Ther. 2018;18(8):793-803. doi:10.1080/14737140.2018.1489245
12. Whelan T, MacKenzie R, Julian J, et al. Randomized trial of breast irradiation schedules after lumpectomy for women with lymph node-negative breast cancer. J Natl Cancer Inst. 2002;94(15):1143-1150. doi:10.1093/jnci/94.15.1143
13. START Trialists’ Group. The UK Standardisation of Breast Radiotherapy (START) Trial A of radiotherapy hypofractionation for treatment of early breast cancer: a randomised trial. Lancet Oncol. 2008;9(4):331-341. doi:10.1016/S1470-2045(08)70077-9
14. START Trialists’ Group. The UK Standardisation of Breast Radiotherapy (START) Trial B of radiotherapy hypofractionation for treatment of early breast cancer: a randomised trial. Lancet. 2008;371(9618):1098-1107. doi:10.1016/S0140-6736(08)60348-7
15. Available from: https://clinicaltrials.gov/show/NCT03414970. Accessed Feb 27, 2018.
16. Sun GY, Wang SL, Song YW, et al. Hypofractionated Radiation Therapy After Mastectomy for the Treatment of High-Risk Breast Cancer: 5-Year Follow-Up Result of a Randomized Trial. Int J Radiat Oncol Biol Phys. 2017;99(2):3-4.
17. Simcock R, Thomas TV, Estes C et al. COVID-19: Global radiation oncology’s targeted response for pandemic preparedness. Clinical and Translational Radiation Oncology. 2020;22:55-68.