Beal Kathryn, McCormick Beryl, Zelefsky Michael J, Borgen Patrick, Fey Jane, Goldberg Jessica, Cohen Gilad N, Sacchini Virgilio
Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA.
Int J Radiat Oncol Biol Phys. 2007 Sep 1;69(1):19-24. doi: 10.1016/j.ijrobp.2007.02.010. Epub 2007 Apr 18.
To evaluate the cosmetic outcome of patients treated with wide local excision and intraoperative radiotherapy for early-stage breast cancer.
A total of 50 women were treated on a pilot study to evaluate the feasibility of intraoperative radiotherapy at wide local excision. The eligibility criteria included age >60, tumor size </=2.0 cm, clinically negative lymph nodes, and biopsy-established diagnosis. After wide local excision, a custom breast applicator was placed in the excision cavity, and a dose of 20 Gy was prescribed to a depth of 1 cm. After 18 patients were treated, the dose was constrained laterally to 18 Gy. The cosmetic outcome was evaluated by photographs at baseline and at 6 and 12 months postoperatively. Four examiners graded the photographs for symmetry, edema, discoloration, contour, and scarring. The grades were evaluated in relationship to the volume of irradiated tissue, tumor location, and dose at the lateral aspects of the cavity.
The median volume of tissue receiving 100% of the prescription dose was 47 cm(3) (range, 20-97 cm(3)). Patients with </=47 cm(3) of treated tissue had better cosmetic outcomes than did the women who had >47 cm(3) of treated tissue. Women who had received 18 Gy at the lateral aspects of their cavities had better cosmetic outcomes than did women who had received 20 Gy at the lateral aspects. When comparing the 6- and 12-month results, the scores remained stable for 63%, improved for 17%, and worsened for 20%.
Intraoperative radiotherapy appears feasible for selected patients. A favorable cosmetic outcome appears to be related to a smaller treatment volume. The cosmetic outcome is acceptable, although additional follow-up is necessary.
评估早期乳腺癌患者接受局部广泛切除联合术中放疗后的美容效果。
共有50名女性参与一项初步研究，以评估术中放疗在局部广泛切除中的可行性。入选标准包括年龄>60岁、肿瘤大小≤2.0 cm、临床腋窝淋巴结阴性以及活检确诊。局部广泛切除后，将定制的乳房施源器置于切除腔内，规定在1 cm深度给予20 Gy的剂量。18例患者治疗后，将外侧剂量限制为18 Gy。通过术前及术后6个月和12个月的照片评估美容效果。四名检查人员对照片的对称性、水肿、变色、外形和瘢痕进行评分。根据照射组织体积、肿瘤位置以及腔外侧的剂量对评分进行评估。
接受100%处方剂量的组织中位体积为47 cm³（范围20 - 97 cm³）。接受治疗组织体积≤47 cm³的患者美容效果优于治疗组织体积>47 cm³的女性。腔外侧接受18 Gy的女性美容效果优于接受20 Gy的女性。比较6个月和12个月的结果，63%的评分保持稳定，17%有所改善，20%恶化。
术中放疗对特定患者似乎可行。良好的美容效果似乎与较小的治疗体积有关。美容效果可以接受，尽管需要进一步随访。
