Vicini Frank A, Antonucci J Vito, Wallace Michelle, Gilbert Samuel, Goldstein Neal S, Kestin Larry, Chen Peter, Kunzman Jonathan, Boike Thomas, Benitez Pamela, Martinez Alvaro
Department of Radiation Oncology, William Beaumont Hospital, Royal Oak, MI 48072, USA.
Int J Radiat Oncol Biol Phys. 2007 Jun 1;68(2):341-6. doi: 10.1016/j.ijrobp.2006.12.007. Epub 2007 Feb 15.
To determine the long-term efficacy and cosmetic results of accelerated partial breast irradiation (APBI) by reviewing our institution's experience.
A total of 199 patients with early-stage breast cancer were treated prospectively with adjuvant APBI after lumpectomy using interstitial brachytherapy. All patients had negative margins, 82% had Stage I disease, median tumor size was 1.1 cm, and 12% had positive lymph nodes. The median follow-up for surviving patients was 8.6 years. Fifty-three patients (27%) have been followed for >or=10 years.
Six ipsilateral breast tumor recurrences (IBTRs) were observed, for a 5-year and 10-year actuarial rate of 1.6% and 3.8%, respectively. A total of three regional nodal failures were observed, for a 10-year actuarial rate of 1.6%. Five contralateral breast cancers developed, for a 5- and 10-year actuarial rate of 2.2% and 5.2%, respectively. The type of IBTR (clonally related vs. clonally distinct) was analyzed using a polymerase chain reaction-based loss of heterozygosity assay. Eighty-three percent of IBTRs (n = 5) were classified as clonally related. Multiple clinical, pathologic, and treatment-related factors were analyzed for an association with the development of an IBTR, regional nodal failure, or contralateral breast cancer. On multivariate analysis, no variable was associated with any of these events. Cosmetic results were rated as excellent/good in 99% of patients.
Long-term results with APBI using interstitial brachytherapy continue to demonstrate excellent long-term local and regional control rates and cosmetic results. According to a polymerase chain reaction-based loss of heterozygosity assay, 83% of recurrences were classified as clonally related.
通过回顾我们机构的经验，确定加速部分乳腺照射（APBI）的长期疗效和美容效果。
共有199例早期乳腺癌患者在肿块切除术后接受辅助性APBI治疗，采用组织间近距离放疗。所有患者切缘阴性，82%为Ⅰ期疾病，肿瘤大小中位数为1.1 cm，12%有阳性淋巴结。存活患者的中位随访时间为8.6年。53例患者（27%）随访时间≥10年。
观察到6例同侧乳腺肿瘤复发（IBTR），5年和10年精算复发率分别为1.6%和3.8%。共观察到3例区域淋巴结转移失败，10年精算转移率为1.6%。发生了5例对侧乳腺癌，5年和10年精算发病率分别为2.2%和5.2%。使用基于聚合酶链反应的杂合性缺失分析来分析IBTR的类型（克隆相关与克隆不同）。83%的IBTR（n = 5）被归类为克隆相关。分析了多种临床、病理和治疗相关因素与IBTR、区域淋巴结转移失败或对侧乳腺癌发生之间的关联。多因素分析显示，没有变量与这些事件中的任何一个相关。99%的患者美容效果评为优秀/良好。
使用组织间近距离放疗的APBI长期结果继续显示出优异的长期局部和区域控制率以及美容效果。根据基于聚合酶链反应的杂合性缺失分析，83%的复发被归类为克隆相关。
