Hennequin C, Durdux C, Espié M, Balla-Mekias S, Housset M, Marty M, Chotin G, Maylin C
Service de Cancérologie-Radiothérapie, Hôpital Saint-Louis, Paris, France.
Int J Radiat Oncol Biol Phys. 1999 Aug 1;45(1):85-90. doi: 10.1016/s0360-3016(99)00139-x.
To evaluate tolerance and efficiency of a boost dose delivered by high-dose-rate brachytherapy (HDRB) in conservative treatment of breast cancer. To evaluate the feasibility of brachytherapy on an out-patient basis.
One hundred and six patients with T1-T2, N0-N1 breast cancers (108 breasts) have been treated with lumpectomy, external irradiation (45 Gy in 5 weeks), and a boost dose on the tumor bed with HDR iridium brachytherapy. Two fractions of 5 Gy were delivered 6 or 24 hours apart. Implantation was done during the lumpectomy (group A: 24 cases) or 3 to 4 weeks after the end of external irradiation (group B: 84 cases). For group B, the application was performed on local anesthesia, and did not require hospitalization. Characteristics of the population were as follows: T1: 77 (71.3%); T2: 31 (28.7%); median tumor size: 1.5 cm; histology: intraductal carcinomas (DCIS): 14 (13%); infiltrative ductal carcinomas (IDC): 84 (77.8%); others: 10 (9.2%). For IDC, surgical margins were found positive in 15 cases, and an extensive intraductal component was present in 22 cases.
All ambulatory HDR implants were performed as planned. No immediate toxicity was noticed, except 5 local hematomas. With a median follow-up of 45 months, 5 local relapses were observed (5-year local relapse rate: 5.1%). Only histological grade III was significantly correlated with local relapse. The 5-year disease-free survival and overall survival were respectively 93.8% and 93.3%. Cosmetic result was evaluated in 87 cases, and was good or excellent in 48 cases (63.2%), acceptable in 27 cases, and poor in 5 cases.
HDRB allows the boost dose to be performed on an out-patient basis. It seems to offer the same local control as other boost techniques for localized breast cancer with acceptable cosmetic results.
评估高剂量率近距离放射治疗（HDRB）给予的推量剂量在乳腺癌保守治疗中的耐受性和有效性。评估门诊近距离放射治疗的可行性。
106例T1-T2、N0-N1期乳腺癌患者（108个乳房）接受了肿块切除术、外照射（5周内45 Gy），并使用HDR铱近距离放射治疗对瘤床给予推量剂量。分两次给予5 Gy，间隔6或24小时。植入操作在肿块切除术中进行（A组：24例）或在外照射结束后3至4周进行（B组：84例）。对于B组，在局部麻醉下进行操作，无需住院。患者群体特征如下：T1期：77例（71.3%）；T2期：31例（28.7%）；肿瘤大小中位数：1.5 cm；组织学类型：导管内癌（DCIS）：14例（13%）；浸润性导管癌（IDC）：84例（77.8%）；其他：10例（9.2%）。对于IDC，手术切缘阳性15例，存在广泛导管内成分22例。
所有门诊HDR植入均按计划进行。除5例局部血肿外，未观察到即刻毒性反应。中位随访45个月，观察到5例局部复发（5年局部复发率：5.1%）。仅组织学III级与局部复发显著相关。5年无病生存率和总生存率分别为93.8%和93.3%。对87例患者的美容效果进行了评估，其中48例（63.2%）为良好或优秀，27例可接受，5例较差。
HDRB允许在门诊进行推量剂量治疗。对于局限性乳腺癌，它似乎能提供与其他推量技术相同的局部控制效果，且美容效果可接受。
