Roddiger Sandra J, Kolotas Christos, Filipowicz Ineza, Kurek Ralf, Kuner Ralph Paul, Martin Thomas, Baltas Dimos, Rogge Bernd, Kontova Marina, Hoffmann Gerald, Pollow Bettina, Zamboglou Nikolaos
Radiation Department, Klinikum Offenbach, Germany.
Strahlenther Onkol. 2006 Jan;182(1):22-9. doi: 10.1007/s00066-006-1454-7.
This is the first study investigating neoadjuvant interstitial high-dose-rate (HDR) brachytherapy combined with chemotherapy in patients with breast cancer. The goal was to evaluate the type of surgical treatment, histopathologic response, side effects, local control, and survival.
53 patients, who could not be treated with breast-conserving surgery due to initial tumor size (36/53) or due to an unfavorable breast-tumor ratio (17/53), were analyzed retrospectively. All but one were in an intermediate/high-risk group (St. Gallen criteria). The patients received a neoadjuvant protocol consisting of systemic chemotherapy combined with fractionated HDR brachytherapy (2 x 5 Gy/day, total dose 30 Gy). In cases, where breast-conserving surgery was performed, patients received additional external-beam radiotherapy (EBRT, 1.8 Gy/day, total dose 50.4 Gy). In patients, who underwent mastectomy but showed an initial tumor size of T3/T4 and/or more than three infiltrated lymph nodes, EBRT was also performed.
In 30/53 patients (56.6%) breast-conserving surgery could be performed. The overall histopathologic response rate was 96.2% with a complete remission in 28.3% of patients. 49/53 patients were evaluable for follow-up. After a median of 58 months (45-72 months), one patient showed a mild fibrosis of the breast tissue, three patients had mild to moderate lymphatic edema of the arm. 6/49 (12.2%) patients died of distant metastases, 4/49 (8.2%) were alive with disease, and 39/49 (79.6%) were free from disease. Local recurrence was observed in only one case (2%) 40 months after primary therapy. After mastectomy, this patient is currently free from disease.
The combination of interstitial HDR brachytherapy and chemotherapy is a well-tolerated and effective neoadjuvant treatment in patients with breast cancer. Compared to EBRT, treatment time is short. Postoperative EBRT of the whole breast -- if necessary -- is still possible after neoadjuvant brachytherapy. Even though the number of patients does not permit definite conclusions, the results are promising regarding survival and the very low rate of local recurrences.
这是第一项研究新辅助间质高剂量率（HDR）近距离放射治疗联合化疗用于乳腺癌患者的研究。目的是评估手术治疗类型、组织病理学反应、副作用、局部控制情况和生存率。
回顾性分析了53例患者，这些患者因初始肿瘤大小（36/53）或乳腺肿瘤比例不佳（17/53）而无法接受保乳手术。除1例患者外，所有患者均属于中/高危组（圣加仑标准）。患者接受了由全身化疗联合分次HDR近距离放射治疗（2×5 Gy/天，总剂量30 Gy）组成的新辅助方案。在接受保乳手术的病例中，患者还接受了额外的外照射放疗（EBRT，1.8 Gy/天，总剂量50.4 Gy）。在接受乳房切除术但初始肿瘤大小为T3/T4和/或有超过三个浸润淋巴结的患者中，也进行了EBRT。
53例患者中有30例（56.6%）可行保乳手术。总体组织病理学缓解率为96.2%，28.3%的患者完全缓解。53例患者中有49例可进行随访评估。中位随访58个月（45 - 72个月）后，1例患者出现乳腺组织轻度纤维化，3例患者手臂出现轻度至中度淋巴水肿。49例患者中有6例（12.2%）死于远处转移，4例（8.2%）带瘤生存，39例（79.6%）无病生存。在初次治疗40个月后仅1例（2%）出现局部复发。乳房切除术后，该患者目前无病生存。
间质HDR近距离放射治疗与化疗联合是一种耐受性良好且有效的乳腺癌新辅助治疗方法。与EBRT相比，治疗时间短。新辅助近距离放射治疗后如有必要，仍可对全乳进行术后EBRT。尽管患者数量不足以得出明确结论，但在生存率和极低的局部复发率方面结果令人鼓舞。
