Niehoff Peter, Dietrich Johanna, Ostertag Horst, Schmid Andreas, Kohr Peter, Kimmig Bernhard, Kovács György
Department of Radiotherapy (Radiooncology), University Hospital of Schleswig-Holstein, Campus Kiel, Arnold-Heller-Strasse 9, 24105 Kiel, Germany.
Strahlenther Onkol. 2006 Feb;182(2):102-7. doi: 10.1007/s00066-006-1496-x.
In patients receiving salvage high-dose-rate (HDR) or pulsed-dose-rate (PDR) brachytherapy for a local recurrence on the chest wall or in the previously treated breast, clinical outcome and benefit were investigated. All patients had previously been treated with full-dose adjuvant external-beam irradiation (EBRT). Disease-free interval after salvage treatment, local tumor control and side effects were analyzed retrospectively.
Between 1996 and 2002, a total of 32 consecutive patients were treated. 13 patients initially treated with mastectomy and postoperative irradiation and 19 patients initially treated with breast-conserving surgery and postoperative irradiation developed a local recurrence. The mean dose of previous radiation therapy was 58 Gy (range, 42-64 Gy), applied by conventional fractionation. After implantation +/- surgery of recurrent disease and CT-based 3-D planning, 15 patients were irradiated with HDR-IMBT (intensity-modulated brachytherapy) with a mean dose of 28 Gy (range, 10-30 Gy, 2 x 2.5 Gy/day at 6-h daily interfraction interval) and 17 patients received PDR-IMBT with a mean dose 30 Gy (range, 10-45 Gy, 5 x 1 Gy/day at 2-h pulse intervals). Four patients underwent additional EBRT using a dose of 24-40 Gy electrons. Treatment was performed only on working days.
After a mean post-implant follow-up of 19 months (range, 1-83 months), no signs of local recurrence were observed in 20 of the 32 patients. In twelve patients, local recurrence occurred after a mean follow-up of 13 months (range, 1-78 months). 20 of the 32 patients experienced an additional systemic progress. In one patient, an EORTC/RTOG grade 3 side effect (ulceration of the skin) was described, which was followed by a local recurrence 12 months posttherapeutically.
Perioperative interstitial HDR/PDR-IMBT of localized breast or thoracic wall recurrences following previous full-dose EBRT appears to be a meaningful salvage treatment with acceptable toxicity.
对接受挽救性高剂量率（HDR）或脉冲剂量率（PDR）近距离放射治疗胸壁或既往治疗过的乳房局部复发患者的临床结局和获益情况进行研究。所有患者既往均接受过全剂量辅助外照射放疗（EBRT）。对挽救治疗后的无病间期、局部肿瘤控制情况及副作用进行回顾性分析。
1996年至2002年期间，共连续治疗了32例患者。13例最初接受乳房切除术及术后放疗，19例最初接受保乳手术及术后放疗的患者出现局部复发。既往放疗的平均剂量为58 Gy（范围42 - 64 Gy），采用常规分割方式。在对复发病灶进行植入±手术及基于CT的三维计划后，15例患者接受了HDR - IMBT（调强近距离放射治疗），平均剂量为28 Gy（范围10 - 30 Gy，每天2次，每次2.5 Gy，两次照射间隔6小时），17例患者接受了PDR - IMBT，平均剂量为30 Gy（范围10 - 45 Gy，每天5次，每次1 Gy，脉冲间隔2小时）。4例患者接受了额外的24 - 40 Gy电子线外照射放疗。治疗仅在工作日进行。
植入后平均随访19个月（范围1 - 83个月），32例患者中有20例未观察到局部复发迹象。12例患者在平均随访13个月（范围1 - 78个月）后出现局部复发。32例患者中有20例出现了额外的全身进展。1例患者出现了欧洲癌症研究与治疗组织（EORTC）/放射肿瘤学组（RTOG）3级副作用（皮肤溃疡），治疗后12个月出现局部复发。
既往接受全剂量EBRT后，对局部乳房或胸壁复发进行围手术期间质HDR/PDR - IMBT似乎是一种毒性可接受的有意义的挽救治疗方法。
