Abstract：
BACKGROUND: To determine the proportion of radiationinduced pneumonitis and pericarditis in patients who have received Hypo-fractionated Radiation along with simultaneous integrated boost technique after breast conservative surgery using a prospective observational study from a tertiary hospital.
METHODS: The incidence of radiationinduced pneumonitis and pericarditis was evaluated in all adult patients with biopsy-proven early-stage unilateral breast cancer who underwent breast-conserving surgery followed by hypo-fractionated radiation with a simultaneous integrated boost technique. Baseline assessments including a six-minute walk test, highresolution computed tomography (HRCT), pulmonary function tests (PFTs), electrocardiography (ECG) and echocardiography (ECHO) were performed. At three months post-radiation treatment, patients underwent follow-up assessments with a six-minute walk test, ECG and ECHO. At six months post-radiation treatment, patients underwent further assessments with a six-minute walk test, ECG, ECHO, PFTs, and HRCT of the thorax. Data analysis was performed using SPSS version 19.
RESULTS: Our study investigated the incidence of acute radiation-induced pneumonitis and pericarditis in patients treated with hypofractionated VMAT-SIB technique in 20 eligible early breast cancer patients. The study found that the technique is feasible and achieves encouraging dosimetric parameters, including well achieved ipsilateral lung and heart doses. The reduced treatment time of 3-4 weeks compared to the previous 6-7 weeks with sequential boost was also found to be desirable in resource-constrained settings. The incidence of acute radiation pneumonitis and pericarditis was acceptable and comparable to existing data, with 90% of patients experiencing grade 1 radiation pneumonitis according to CTCAE v5.0. Post-treatment pulmonary function tests showed significant changes, particularly in patients who had received neoadjuvant chemotherapy and nodal irradiation. The six-minute walk test and Borg scale also showed a significant positive correlation with pulmonary function tests. There was no significant pericarditis during the follow-up. The study proposes that the hypofractionated radiotherapy using VMAT-SIB is a suitable alternative to conventional fractionation, with acceptable acute toxicities, but longer follow-up is required to assess the impact on late toxicities.
CONCLUSIONS: Our research has shown that hypofractionated adjuvant radiotherapy with SIB is a safe and feasible treatment for patients with early breast cancer. This treatment method doesn\'t pose any significant short-term risks to the lungs or heart, and the SIB technique provides better coverage, conformity and sparing of organs at risk. Additionally, patients have reported positive cosmetic outcomes with this treatment. However, to make more accurate conclusions, we need to conduct further studies with larger sample sizes and longer follow-up periods to evaluate the potential longterm side effects of this treatment using VMAT in whole breast radiation.
METHODS: The incidence of radiationinduced pneumonitis and pericarditis was evaluated in all adult patients with biopsy-proven early-stage unilateral breast cancer who underwent breast-conserving surgery followed by hypo-fractionated radiation with a simultaneous integrated boost technique. Baseline assessments including a six-minute walk test, highresolution computed tomography (HRCT), pulmonary function tests (PFTs), electrocardiography (ECG) and echocardiography (ECHO) were performed. At three months post-radiation treatment, patients underwent follow-up assessments with a six-minute walk test, ECG and ECHO. At six months post-radiation treatment, patients underwent further assessments with a six-minute walk test, ECG, ECHO, PFTs, and HRCT of the thorax. Data analysis was performed using SPSS version 19.
RESULTS: Our study investigated the incidence of acute radiation-induced pneumonitis and pericarditis in patients treated with hypofractionated VMAT-SIB technique in 20 eligible early breast cancer patients. The study found that the technique is feasible and achieves encouraging dosimetric parameters, including well achieved ipsilateral lung and heart doses. The reduced treatment time of 3-4 weeks compared to the previous 6-7 weeks with sequential boost was also found to be desirable in resource-constrained settings. The incidence of acute radiation pneumonitis and pericarditis was acceptable and comparable to existing data, with 90% of patients experiencing grade 1 radiation pneumonitis according to CTCAE v5.0. Post-treatment pulmonary function tests showed significant changes, particularly in patients who had received neoadjuvant chemotherapy and nodal irradiation. The six-minute walk test and Borg scale also showed a significant positive correlation with pulmonary function tests. There was no significant pericarditis during the follow-up. The study proposes that the hypofractionated radiotherapy using VMAT-SIB is a suitable alternative to conventional fractionation, with acceptable acute toxicities, but longer follow-up is required to assess the impact on late toxicities.
CONCLUSIONS: Our research has shown that hypofractionated adjuvant radiotherapy with SIB is a safe and feasible treatment for patients with early breast cancer. This treatment method doesn\'t pose any significant short-term risks to the lungs or heart, and the SIB technique provides better coverage, conformity and sparing of organs at risk. Additionally, patients have reported positive cosmetic outcomes with this treatment. However, to make more accurate conclusions, we need to conduct further studies with larger sample sizes and longer follow-up periods to evaluate the potential longterm side effects of this treatment using VMAT in whole breast radiation.
摘要：
背景：通过一项来自三级医院的前瞻性观察性研究，确定在乳房保守性手术后接受低分割放疗并同时整合升压技术的患者中放射诱发的肺炎和心包炎的比例。
方法：对所有经活检证实的早期单侧乳腺癌成年患者进行了乳腺保乳手术，然后进行了低分割放疗，同时进行了综合增强技术，评估了放射性肺炎和心包炎的发生率。基线评估包括六分钟步行测试，高分辨率计算机断层扫描（HRCT），肺功能测试（PFTs），进行心电图（ECG）和超声心动图（ECHO）检查。放射治疗后三个月，患者接受了6分钟步行测试的随访评估，心电图和ECHO。放射治疗后六个月，通过六分钟步行测试对患者进行进一步评估，心电图,ECHO,PFTs,和胸部的HRCT。使用SPSS版本19进行数据分析。
结果：我们的研究调查了20例符合资格的早期乳腺癌患者接受大分割VMAT-SIB技术治疗的急性放射性肺炎和心包炎的发生率。研究发现，该技术是可行的，实现了令人鼓舞的剂量学参数，包括获得良好的同侧肺和心脏剂量。与之前的6-7周相比,3-4周的治疗时间减少,在资源受限的环境中也发现是期望的。急性放射性肺炎和心包炎的发生率是可以接受的，与现有数据相当。根据CTCAEv5.0，90%的患者经历1级放射性肺炎。治疗后肺功能检查显示明显变化,特别是在接受新辅助化疗和淋巴结照射的患者中。六分钟步行试验和Borg量表也显示与肺功能检查呈显着正相关。随访期间无明显心包炎。该研究提出，使用VMAT-SIB的大分割放射治疗是传统分割的合适替代方案，具有可接受的急性毒性，但需要更长时间的随访来评估对晚期毒性的影响.
结论：我们的研究表明，对于早期乳腺癌患者，带SIB的小分割辅助放疗是一种安全可行的治疗方法。这种治疗方法不会对肺部或心脏造成任何重大的短期风险，SIB技术提供了更好的覆盖，整合和保留处于危险中的器官。此外,患者报告该治疗的美容结果为阳性.然而,为了做出更准确的结论，我们需要用更大的样本量和更长的随访时间进行进一步的研究,以评估在全乳放疗中使用VMAT治疗的潜在长期副作用.
方法：对所有经活检证实的早期单侧乳腺癌成年患者进行了乳腺保乳手术，然后进行了低分割放疗，同时进行了综合增强技术，评估了放射性肺炎和心包炎的发生率。基线评估包括六分钟步行测试，高分辨率计算机断层扫描（HRCT），肺功能测试（PFTs），进行心电图（ECG）和超声心动图（ECHO）检查。放射治疗后三个月，患者接受了6分钟步行测试的随访评估，心电图和ECHO。放射治疗后六个月，通过六分钟步行测试对患者进行进一步评估，心电图,ECHO,PFTs,和胸部的HRCT。使用SPSS版本19进行数据分析。
结果：我们的研究调查了20例符合资格的早期乳腺癌患者接受大分割VMAT-SIB技术治疗的急性放射性肺炎和心包炎的发生率。研究发现，该技术是可行的，实现了令人鼓舞的剂量学参数，包括获得良好的同侧肺和心脏剂量。与之前的6-7周相比,3-4周的治疗时间减少,在资源受限的环境中也发现是期望的。急性放射性肺炎和心包炎的发生率是可以接受的，与现有数据相当。根据CTCAEv5.0，90%的患者经历1级放射性肺炎。治疗后肺功能检查显示明显变化,特别是在接受新辅助化疗和淋巴结照射的患者中。六分钟步行试验和Borg量表也显示与肺功能检查呈显着正相关。随访期间无明显心包炎。该研究提出，使用VMAT-SIB的大分割放射治疗是传统分割的合适替代方案，具有可接受的急性毒性，但需要更长时间的随访来评估对晚期毒性的影响.
结论：我们的研究表明，对于早期乳腺癌患者，带SIB的小分割辅助放疗是一种安全可行的治疗方法。这种治疗方法不会对肺部或心脏造成任何重大的短期风险，SIB技术提供了更好的覆盖，整合和保留处于危险中的器官。此外,患者报告该治疗的美容结果为阳性.然而,为了做出更准确的结论，我们需要用更大的样本量和更长的随访时间进行进一步的研究,以评估在全乳放疗中使用VMAT治疗的潜在长期副作用.
