Polgár C, Major T, Somogyi A, Fodor J, Sulyok Z, Tóth J, Forrai G, Németh G
Sugárterápiás Osztály, Országos Onkológiai Intézet, Budapest.
Orv Hetil. 1999 Jun 27;140(26):1461-6.
To initiate fractionated, interstitial high dose rate brachytherapy of the tumour bed as the sole radiation modality after breast conserving surgery.
In 41 cases of selected stage I-II breast cancer the tumour bed was marked with titanium clips during breast conserving surgery. The tumour bed was implanted with flexible plastic catheters to deliver postoperative radiotherapy. In 8 cases 7 x 4.33 Gy (30.3 Gy), in 33 cases 7 x 5.2 Gy (36.4 Gy) interstitial 192Ir high dose rate brachytherapy was given to the clipped area. Irradiation of the whole conserved breast was omitted. The radiation side effects were assessed by mammograms and MRI-examinations.
At a median follow up of 17 (4-36) months neither distant nor regional failure was observed. Local recurrence was detected in 1/41 (2.4%) case. G2 radiation side effects were observed in 2/21 (9.5%).
Postoperative sole brachytherapy of the tumour bed with careful patient selection and adequate quality assurance seems to be a feasible alternative to whole breast teletherapy. Sole brachytherapy shortens the time of radiotherapy from 5-6 weeks to 5 days, and reduces the costs of treatment. The skin and volume sparing effect of interstitial irradiation may decrease the side effects of radiotherapy.
在保乳手术后，启动对瘤床的分割间质高剂量率近距离放射治疗作为唯一的放疗方式。
在41例经选择的Ⅰ-Ⅱ期乳腺癌患者中，在保乳手术期间用钛夹标记瘤床。在瘤床植入可弯曲的塑料导管以进行术后放疗。8例患者接受7次，每次4.33 Gy（共30.3 Gy），33例患者接受7次，每次5.2 Gy（共36.4 Gy）的间质192Ir高剂量率近距离放射治疗，照射标记区域。省略对整个保留乳房的照射。通过乳房X线照片和MRI检查评估放疗副作用。
中位随访17（4 - 36）个月，未观察到远处或区域复发。在1/41（2.4%）的病例中检测到局部复发。在2/21（9.5%）的患者中观察到2级放疗副作用。
经过仔细的患者选择和充分的质量保证，对瘤床进行术后单纯近距离放射治疗似乎是全乳远距离放疗的一种可行替代方案。单纯近距离放射治疗将放疗时间从5 - 6周缩短至5天，并降低了治疗成本。间质照射对皮肤和体积的 sparing 效应可能会降低放疗的副作用。 （注：“sparing”可能是“ sparing effect”的拼写错误，推测这里想表达“ sparing effect”，意为“ sparing 效应”，但由于原文如此，所以保留英文。）
