Richards Gregory M, Berson Anthony M, Rescigno John, Sanghavi Seema, Siegel Beth, Axelrod Deborah, Bernik Stephanie, Scarpinato Vincent, Mills Christopher
Department of Radiation Oncology, St. Vincent's Comprehensive Cancer Center, 325 W. 15th Street, New York, NY 10011, USA.
Ann Surg Oncol. 2004 Aug;11(8):739-46. doi: 10.1245/ASO.2004.02.009. Epub 2004 Jul 12.
Intracavitary brachytherapy with the MammoSite applicator as the sole radiation treatment in breast-conserving therapy is an option for women with early-stage breast cancer; we evaluated the acute toxicities associated with this treatment method.
Thirty-one patients with 32 stage I or II breast carcinomas underwent breast-conserving therapy, which included lumpectomy with negative margins, sentinel node biopsy, or axillary dissection, followed by brachytherapy with the MammoSite applicator. Acute radiation skin complications were graded on the day of radiotherapy completion and at weeks 2, 4, 6, and 12 after radiation treatment. Cosmesis was graded on the Harvard Scale at all follow-ups.
The median follow-up was 11 months (range, 4-15 months). Twenty-seven of the 31 patients were treated with the device as the sole method of radiotherapy. No acute toxicities occurred during the 5 days of treatment. Nineteen patients (68%) had no to mild acute skin reactions, and 25% developed bright erythema and patchy moist desquamation. Two patients (7%) developed confluent moist desquamation within the first 4 weeks (grade 3); this healed by week 12. All skin reactions were localized to the area overlying the balloon. Sixteen percent (5 of 32) of all breasts with implants developed infection. Cosmesis was good to excellent in 86% of cases.
Most acute skin toxicities were mild. Our infection rate was higher than in prior studies that used interstitial brachytherapy. Cosmesis was good to excellent in most patients. Breast brachytherapy with the MammoSite catheter was well tolerated; further investigations of breast brachytherapy with this system are warranted.
在保乳治疗中，使用MammoSite施源器进行腔内近距离放射治疗是早期乳腺癌女性的一种选择；我们评估了与这种治疗方法相关的急性毒性。
31例患有32例I期或II期乳腺癌的患者接受了保乳治疗，包括切缘阴性的肿块切除术、前哨淋巴结活检或腋窝清扫术，随后使用MammoSite施源器进行近距离放射治疗。在放疗完成当天以及放疗后第2、4、6和12周对急性放射性皮肤并发症进行分级。在所有随访中，按照哈佛量表对美容效果进行分级。
中位随访时间为11个月（范围4 - 15个月）。31例患者中有27例将该设备作为唯一的放射治疗方法。在5天的治疗期间未发生急性毒性反应。19例患者（68%）没有至轻度急性皮肤反应，25%出现明显红斑和片状湿性脱皮。2例患者（7%）在最初4周内出现融合性湿性脱皮（3级）；在第12周时愈合。所有皮肤反应均局限于球囊上方区域。植入物的所有乳房中有16%（32例中的5例）发生感染。86%的病例美容效果良好至优秀。
大多数急性皮肤毒性反应较轻。我们的感染率高于先前使用组织间近距离放射治疗的研究。大多数患者的美容效果良好至优秀。使用MammoSite导管进行乳房近距离放射治疗耐受性良好；有必要对该系统的乳房近距离放射治疗进行进一步研究。
