الفهرس 
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Abstract
Recent recommendations regarding indications of accelerated partial breast irradiation (APBI) have been put forward for selected breast cancer patients. In this study 65 patients were recruited to test the tolerance of two levels of dose for APBI. Patients were divided into two groups; the first receiving the dose of 40 Gy/10 fractions/5 days and the second group receiving a dose of 42 Gy/10 fractions/ 5 days.
The aim of this work is to comprehensively describe the Taghian technique (MGH) for 3D CRT EBRT APBI. To assess and compare the incidence of early and late radiation toxicity between the two level of doses after 24 months of follow up. To correlate the incidence of fibrosis with a nomogram for prediction of the risk of fibrosis and the lymphocyte apoptosis assay.
from the 65 patients who met the inclusion criteria, 17 failed to meet the dosimetric constraints. The remaining 48 pT1N0 BC patients were divided as follow: 17 patients at a dose of 42 Gy/10f/5d and 31 at a dose of 40 Gy/10f/5d. All the patients were treated by APBI using a technique with 2 minitangents and an “enface” electrons delivering 20% of the total dose. Toxicities were systematically assessed at 1; 2; 6 months and then every 6 months. Patients’ recruitment of 42 Gy step was ended owing to persistent grade 3 toxicity in the year that follows APBI completion (persistent Hyperpigmentation and painful induration at the irradiated area) (n = 1).
Early toxicities were statistically higher after a total dose of 42 Gy regarding grade ≥2 dry (p = 0.01) and moist (p = 0.05) skin desquamation. As for late toxicities at 24 months: grade ≥2 fibrosis and hyperpigmentation were statistically different between 42 Gy and 40 Gy.
There was a statistically significant correlation between the nommogram score and the incidence of fibrosis grade ≥ 2. The lymphocyte apoptosis assay failed to correlate with the higher risk of fibrosis. As the number of events was not statistically sufficient, a larger number of patients is needed to confirm these results.
Early toxicities were more severe and higher rates of late toxicities at 24 months were observed after 42 Gy/10 fractions/5 days when compared to 40 Gy/10 fractions/5 days. This data suggest that 40 Gy/10 fractions/ 5 days could potentially be the maximum tolerance for PBI although longer follow-up is warranted to better assess late toxicities.