.: ORİJİNAL ARAŞTIRMA
Lokal İleri Evre Meme Kanserli Hastalarda Konformal Radyoterapiye Bağlı Özofajit Gelişimi
Radiation Induced Esophagitis in Patients with Locally Advanced Breast Cancer Who Underwent Conformal Radiotherapy
Turkiye Klinikleri J Med Sci.2020;40(4):451-7
doi: 10.5336/medsci.2020-74824
Makale Dili: TR
Tam Metin
ÖZET
Amaç: Bu çalışmanın amacı, lokal ileri evre meme kanseri tanısı ile adjuvan radyoterapi uygulanan hastalarda radyoterapiye bağlı özofajit insidansının ve özofajit gelişimine etki eden dozimetrik faktörlerin araştırılmasıdır. Gereç ve Yöntemler: 2014-2019 yılları arasında, lokal ileri evre meme kanseri tanısı ile supraklavikular alan ve aksiller nodal bölgeye konformal radyoterapi uygulanmış, toplam 213 hastanın tedavi planları retrospektif olarak değerlendirilmiştir. Radyoterapi planlama tomografisi üzerinde özofagus, üst, orta ve alt olmak üzere 3 bölüme ayrılmıştır. Radyoterapiye bağlı özofajit gelişen ve özofajit gelişmeyen hasta grupları belirlenmiş ve dozimetrik verileri karşılaştırılmıştır. Bulgular: Değerlendirilen 213 hastadan, ortalama 15 (5-25) fraksiyon sonrasında Grade 1 özofajit gelişen 48 hasta (%22) tespit edilmiştir. Üst özofagus ortalama doz (Dmean) değeri özofajit gelişen hastalarda, özofajit gelişmeyen hastalara göre %37,9 oranında daha fazla bulunmuştur (p=0,007). Üst özofagus Dmean değeri özofajit gelişen 24/48 hastada >7,9 Gy, özofajit gelişmeyen 109/165 hastada ≤7,9 Gy bulunmuştur (OR=1,94, %95 CI=1,01-3,73, p=0,043). Sonuç: Lokal ileri evre meme kanseri nedeniyle konformal radyoterapi uygulanan hastalar da özofagus radyasyon dozuna maruz kalmaktadır. Bulgulara göre radyoterapi planlama sırasında supraklavikular alana komşu üst özofagus dozu mümkünse 7,9 Gy dozda sınırlandırılması radyoterapiye bağlı özofajit riskini azaltabilir.
Anahtar Kelimeler: Meme kanseri; özofajit; radyoterapi
Amaç: Bu çalışmanın amacı, lokal ileri evre meme kanseri tanısı ile adjuvan radyoterapi uygulanan hastalarda radyoterapiye bağlı özofajit insidansının ve özofajit gelişimine etki eden dozimetrik faktörlerin araştırılmasıdır. Gereç ve Yöntemler: 2014-2019 yılları arasında, lokal ileri evre meme kanseri tanısı ile supraklavikular alan ve aksiller nodal bölgeye konformal radyoterapi uygulanmış, toplam 213 hastanın tedavi planları retrospektif olarak değerlendirilmiştir. Radyoterapi planlama tomografisi üzerinde özofagus, üst, orta ve alt olmak üzere 3 bölüme ayrılmıştır. Radyoterapiye bağlı özofajit gelişen ve özofajit gelişmeyen hasta grupları belirlenmiş ve dozimetrik verileri karşılaştırılmıştır. Bulgular: Değerlendirilen 213 hastadan, ortalama 15 (5-25) fraksiyon sonrasında Grade 1 özofajit gelişen 48 hasta (%22) tespit edilmiştir. Üst özofagus ortalama doz (Dmean) değeri özofajit gelişen hastalarda, özofajit gelişmeyen hastalara göre %37,9 oranında daha fazla bulunmuştur (p=0,007). Üst özofagus Dmean değeri özofajit gelişen 24/48 hastada >7,9 Gy, özofajit gelişmeyen 109/165 hastada ≤7,9 Gy bulunmuştur (OR=1,94, %95 CI=1,01-3,73, p=0,043). Sonuç: Lokal ileri evre meme kanseri nedeniyle konformal radyoterapi uygulanan hastalar da özofagus radyasyon dozuna maruz kalmaktadır. Bulgulara göre radyoterapi planlama sırasında supraklavikular alana komşu üst özofagus dozu mümkünse 7,9 Gy dozda sınırlandırılması radyoterapiye bağlı özofajit riskini azaltabilir.
Anahtar Kelimeler: Meme kanseri; özofajit; radyoterapi
ABSTRACT
Objective: The aim of this study was to evaluate the incidence of acute esophagitis and dosimetric factors effecting the development of mild esophagitis in patients with locally advanced breast cancer who treated with adjuvant conformal radiotherapy. Material and Methods: The radiotherapy treatment plans of 213 locally advanced breast cancer patients receiving conformal radiotherapy to supraclavicular fossa and axillary nodal area between 2014- 2019, were retrospectively evaluated. Total esophagus was divided into 3 segments as upper, middle and lower parts on the treatment planning tomography. Two groups were identified as patients who experienced esophagitis and patients who did not experience esophagitis. The dosimetric data of two groups were compared. Results: Evaluation of 213 patients showed that 48 patients (22%) reported grade1 esophagitis after 15 (5-25) fraction in average. The mean dose (Dmean) of upper esophagus was significantly larger in patients who experienced esophagitis in the ratio of 37,9% compared to ones did not (p=0.007). The upper oesophageal Dmean value was found >7.9 Gy in 24/48 patients who experienced esophagitis and ≤7.9 Gy in 109/165 patients who did not experience esophagitis (OR=1.94, %95 CI=1.01-3.73, p=0.043). Conclusions: Esophagus is exposed to certain dose of radiation in patients with locally advanced breast cancer who underwent conformal radiotherapy. According to the results, the risk of radiation induced esophagitis can be diminished by limiting the dose of upper esophagus as 7.9 Gy that is neighbor to the supraclavicular area during the conformal radiotherapy planning.
Keywords: Breast cancer; esophagitis; radiotherapy
Objective: The aim of this study was to evaluate the incidence of acute esophagitis and dosimetric factors effecting the development of mild esophagitis in patients with locally advanced breast cancer who treated with adjuvant conformal radiotherapy. Material and Methods: The radiotherapy treatment plans of 213 locally advanced breast cancer patients receiving conformal radiotherapy to supraclavicular fossa and axillary nodal area between 2014- 2019, were retrospectively evaluated. Total esophagus was divided into 3 segments as upper, middle and lower parts on the treatment planning tomography. Two groups were identified as patients who experienced esophagitis and patients who did not experience esophagitis. The dosimetric data of two groups were compared. Results: Evaluation of 213 patients showed that 48 patients (22%) reported grade1 esophagitis after 15 (5-25) fraction in average. The mean dose (Dmean) of upper esophagus was significantly larger in patients who experienced esophagitis in the ratio of 37,9% compared to ones did not (p=0.007). The upper oesophageal Dmean value was found >7.9 Gy in 24/48 patients who experienced esophagitis and ≤7.9 Gy in 109/165 patients who did not experience esophagitis (OR=1.94, %95 CI=1.01-3.73, p=0.043). Conclusions: Esophagus is exposed to certain dose of radiation in patients with locally advanced breast cancer who underwent conformal radiotherapy. According to the results, the risk of radiation induced esophagitis can be diminished by limiting the dose of upper esophagus as 7.9 Gy that is neighbor to the supraclavicular area during the conformal radiotherapy planning.
Keywords: Breast cancer; esophagitis; radiotherapy
REFERANSLAR:
- SEER. Cancer stat facts: female breast cancer. National Cancer İnstitute. Bethesda, MD.[Link]
- Halperin CE, Wazer DE, Perez CA, Brady LW. Breast cancer. In: Principle and Practice of Radiation Oncology. 7th ed. Philadelphia: Wolters Kluwer, 2018:1038-1095.
- Ragaz J, Olivotto IA, Spinelli JJ, Phillips N, Jackson SM, Wilson KS, et al. Locoregional radiation therapy in patients with high-risk breast cancer receiving adjuvant chemotherapy: 20-year results of the British Columbia randomized trial. J Natl Cancer Inst. 2005;97(2):116-26.[Crossref] [PubMed]
- Budach W, Bölke E, Kammers K, Gerber PA, Nestle-Krämling C, Matuschek C, et al. Adjuvant radiation therapy of regional lymph nodes in breast cancer - a meta-analysis of randomized trials- an update. Radiat Oncol. 2015;21;10:258.[Crossref] [PubMed] [PMC]
- Lamart S, Stovall M, Simon SL, Smith SA, Weathers RE, Howell RM, et al. Radiation dose to the esophagus from breast cancer radiation therapy, 1943-1996: an international population-based study of 414 patients. Int J Radiat Oncol Biol Phys. 2013;15;86(4):694-701.[Crossref] [PubMed]
- Nesheiwat Z, Akbar H, Kahloon A, Mahajan K. Radiation esophagitis. StatPearls [Internet].[Link]
- Murro D, Jakate S. Radiation esophagitis. Arch Pathol Lab Med. 2015;139(6):827-30.[Crossref] [PubMed]
- Yu Y, Guan H, Dong Y, Xing L, Li X. Advances in dosimetry and biological predictors of radiation-induced esophagitis. Onco Targets Ther. 2016;28;9:597-603.[Crossref] [PubMed] [PMC]
- Jelvehgaran P, Steinberg JD, Khmelinskii A, Borst G, Song JY, de Wit N, et al. Evaluation of acute esophageal radiation-induced damage using magnetic resonance imaging: a feasibility study in mice. Radiat Oncol. 2019;30;14(1):188.[Crossref] [PubMed] [PMC]
- Türkölmez S, Atasever T, Akmansu M. Effects of radiation therapy on oesophageal transit in patients with inner quadrant breast tumour. Nucl Med Commun. 2005;26(8):721-6.[Crossref] [PubMed]
- Caussa L, Kirova YM, Gault N, Pierga JY, Savignoni A, Campana F, et al. The acute skin and heart toxicity of a concurrent association of trastuzumab and locoregional breast radiotherapy including internal mammary chain: a single-institution study. Eur J Cancer. 2011;47(1):65-73.[Crossref] [PubMed]
- Wang Q, Jie W, Liang Z, Wu H, Cheng J. Postmastectomy intensity modulation radiated therapy of chest wall and regional nodes: Retrospective analysis of the performance and complications up for 5 years. Medicine (Baltimore). 2017;96(39):e7956.[Crossref] [PubMed] [PMC]
- West K, Schneider M, Wright C, Beldham-Collins R, Coburn N, Tiver K, et al. Radiation-induced oesophagitis in breast cancer: factors influencing onset and severity for patients receiving supraclavicular nodal irradiation. J Med Imaging Radiat Oncol. 2020;64(1):113-9.[Crossref] [PubMed]
- Cox JD, Stetz J, Pajak TF. Toxicity criteria of the Radiation Therapy Oncology Group (RTOG) and the European Organization for Research and Treatment of Cancer (EORTC). Int J Radiat Oncol Biol Phys. 1995; 30;31(5):1341-6.[Crossref] [PubMed]
- White J, Tai A, Arthur D, Buchholz T, MacDonald S, Marks L, et al. Breast cancer atlas for radiation therapy planning: consensus definition. Avaible from: (Kaynağa direkt ulaşılabilen link verilmelidir.)[Link]
- Chaudry SR, Bordoni B. Anatomy, thorax, esophagus. StatPearls [Internet].[Link]
.: İşlem Listesi