International journal of radiation oncology, biology, physics · 2026
Incidence and Predictors of Fat Necrosis After Single-Fraction Stereotactic Partial Breast Irradiation for Early-Stage Breast Cancer: Results From a Phase 2 Clinical Trial.
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Facondo Giuseppe, Prisco Agnese, Reverberi Chiara, Festa Eleonora, Moretti Eugenia, Bassi Sarah, Marfisi Daniela, Scalchi Paolo, Trovò Marco
Аннотация
PURPOSE: To evaluate predictive dosimetric factors for fat necrosis (FN) after postoperative single-fraction stereotactic partial breast irradiation (S-PBI) in early-stage breast cancer.
METHODS AND MATERIALS: This prospective, single-institution phase 2 trial enrolled 148 patients who received breast-conserving surgery followed by S-PBI. Treatment consisted of a single 17.5 Gy fraction prescribed to 95% of the planning target volume (PTV) using GammaPod. The nominal dose was 18.4 Gy. FN was evaluated clinically at each follow-up. FN was classified into 2 categories: FN detected only by imaging (mammography or contrast-enhanced mammography) and FN detected by imaging and associated with clinical symptoms. To describe the cumulative incidence of FN over time after S-PBI, we used the Kaplan-Meier method. Univariate and stepwise logistic regression analyses were conducted to evaluate predictive factors associated with FN.
RESULTS: Between January 2022 and May 2024, 148 patients were enrolled. Median age at diagnosis was 68 years (IQR, 58-74). Median follow-up was 29.9 months (IQR, 23.5-38.8). Median whole-breast volume was 1242.63 cm3 (IQR, 722.69-1394.42). Median PTV was 43.6 cm3 (IQR, 32.6-58.5). Median V19.3 (105%) was 0.55 cm3. Eighteen patients (12.1%) developed FN and 6 patients (4.1%) symptomatic FN. The incidence rates of FN at 6, 12, 18, and 24 months were 1.4%, 6.8%, 9.5%, and 11.3%, respectively. The incidence rates of symptomatic FN at 6, 12, 18, and 24 months were 0.7%, 2.7%, 3.4%, and 4.6%, respectively. Age ≥60 years and dosimetric parameter V19.3 were independently associated with an increased risk of FN. Specifically, V19.3 ≥5 cc was a strong predictor of overall FN, while V19.3% (continuous) was the only significant predictor for symptomatic FN. PTV showed only a borderline association.
CONCLUSIONS: The use of S-PBI with GammaPod is confirmed to be a well-tolerated strategy with a relatively low incidence of FN. Advanced age and volume of mammary gland exposed to higher doses represent the main risk predictors.
METHODS AND MATERIALS: This prospective, single-institution phase 2 trial enrolled 148 patients who received breast-conserving surgery followed by S-PBI. Treatment consisted of a single 17.5 Gy fraction prescribed to 95% of the planning target volume (PTV) using GammaPod. The nominal dose was 18.4 Gy. FN was evaluated clinically at each follow-up. FN was classified into 2 categories: FN detected only by imaging (mammography or contrast-enhanced mammography) and FN detected by imaging and associated with clinical symptoms. To describe the cumulative incidence of FN over time after S-PBI, we used the Kaplan-Meier method. Univariate and stepwise logistic regression analyses were conducted to evaluate predictive factors associated with FN.
RESULTS: Between January 2022 and May 2024, 148 patients were enrolled. Median age at diagnosis was 68 years (IQR, 58-74). Median follow-up was 29.9 months (IQR, 23.5-38.8). Median whole-breast volume was 1242.63 cm3 (IQR, 722.69-1394.42). Median PTV was 43.6 cm3 (IQR, 32.6-58.5). Median V19.3 (105%) was 0.55 cm3. Eighteen patients (12.1%) developed FN and 6 patients (4.1%) symptomatic FN. The incidence rates of FN at 6, 12, 18, and 24 months were 1.4%, 6.8%, 9.5%, and 11.3%, respectively. The incidence rates of symptomatic FN at 6, 12, 18, and 24 months were 0.7%, 2.7%, 3.4%, and 4.6%, respectively. Age ≥60 years and dosimetric parameter V19.3 were independently associated with an increased risk of FN. Specifically, V19.3 ≥5 cc was a strong predictor of overall FN, while V19.3% (continuous) was the only significant predictor for symptomatic FN. PTV showed only a borderline association.
CONCLUSIONS: The use of S-PBI with GammaPod is confirmed to be a well-tolerated strategy with a relatively low incidence of FN. Advanced age and volume of mammary gland exposed to higher doses represent the main risk predictors.