الفهرس 
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Abstract
This is a phase III randomized trial comparing whole breast irradiation (WBI) vs. accelerated partial breast irradiation (APBI) for patients with stage I&II breast cancer treated with breast conserving surgery.Between January 2012 and October 2013, 60 patients were enrolled onto this study, 30 patients in each treatment arm. Patients in the APBI group received 3850 cGy/10F given twice daily with a minimum of 6 hours apart, while patients in the WBI group received 5000 cGy/25F in 5 weeks with an additional 10Gy/5F boost to the tumor bed.The aim of this study was to compare local tumor control, overall survival, toxicity (acute and late), and cosmesis in women treated with either APBI or WBI.The median age of patients was 47 years (52 in the WBI arm and 46 in the APBI arm). The mean tumor size was 1.96 cm (1.8 in the APBI and 2.1 in the WBI arm). Five (16.6%) patients in the APBI arm had metastatic axillary lymph nodes while 4 patients (13.4%) had node positive disease in the WBI arm.At a median follow up of 17.4 months, none of the patients experienced local, regional or distant recurrences. All patients were alive at the time of last follow up.When compared to WBI, APBI resulted in lower dose received by the ipsilateral lung. The mean V10 was 10.2% vs. 31.4%, p 0.02 and mean V20 was 3.83% vs. 23.07%, p 0.001, for APBI and WBI respectively. Similarly, the comparison of the dose received by the heart using the APBI and WBI showed that the APBI delivered a significantly lower mean dose than WBI.The mean radiation dose to the heart in the APBI group was 341.2 cGy vs. 1004.5 for the WBI arm (p 0.0001).More patients in the WBI group experienced GIII/IV acute skin toxicity. The rate of GIII/IV toxicity in the APBI group was 17.2 % compared to 76.7% in the WBI group (p 0.001). On a scale of 1-10, the mean pain score experienced during the course of radiation therapy in the APBI group was 4 while the mean pain score in the WBI group was 6 and this difference was statistically significant (p 0.001).Late subcutaneous fibrosis of grade I or II was observed in 25 patients in the APBI arm and in 28 patients in the WBI arm, however, this difference was not statistically significant.The cosmetic results were evaluated using the EORTC cosmesis evaluation score prior to initiation of radiation and the process was repeated at six and twelve months after the end of treatment.At baseline, more patients in the APBI arm (96.7%) had excellent/good cosmesis vs. 90% in the WBI arm. The percentage of patients with excellent/good cosmesis in the APBI dropped at the 6 months evaluation after treatment to 83.3% and a second DROP was observed at the 12 months evaluation to reach 78.6% and this was lower than the percentage of patients with excellent/good cosmesis in the WBI arm (83.3%) as found at the same follow up time.The net result was that 11(36.7%) patients in the APBI group experienced worsening in their cosmetic outcome compared with 6(20%) patients only in the WBI group. However, the difference was not statistically significant.