Gómez-Iturriaga Alfonso, Pina Luis, Cambeiro Mauricio, Martínez-Regueira Fernando, Aramendía José Manuel, Fernández-Hidalgo Oscar, Martínez-Monge Rafael
Department of Oncology, University of Navarra, Pamplona, Navarra, Spain.
Brachytherapy. 2008 Oct-Dec;7(4):310-5. doi: 10.1016/j.brachy.2008.04.006. Epub 2008 Sep 7.
To evaluate the feasibility and intermediate-term results of conservative surgery, adjuvant chemotherapy, and delayed accelerated partial breast irradiation (APBI) with high-dose-rate brachytherapy.
Between 2000 and 2007, a total of 26 patients with a median age of 54 years were treated with conservative surgery followed by adjuvant chemotherapy and exclusive high-dose-rate brachytherapy. Inclusion criteria followed the Radiation Therapy Oncology Group 95-17 trial guidelines. The tumor bed was marked at the time of surgery (n = 2) or before brachytherapy (n = 24). The brachytherapy procedure was performed at a median of 22 weeks after surgery. A median of 14 brachytherapy catheters were placed in three to four parallel planes. A dose of 34.0 Gy in 10 b.i.d. fractions given over 5 consecutive days was prescribed to the clinical target volume (CTV90).
After a median followup of 53 months (range, 6.8-81), Radiation Therapy Oncology Group Grade 1-2 events and Grade 3 events were observed in 10 (38.4%) patients and 3 (11.5%) patients, respectively. No Grade 4-5 events were observed. Patients rated their cosmetic result as excellent (37.5%), good (50.0%), fair (8%), or poor (4%) based on the Wazer's Criteria. The 6-year actuarial local, elsewhere in the breast, and distant control rates were 100%, 96.2%, and 96.2%, respectively. Six-year disease-free survival and overall survival were 92.3% and 96.2%, respectively.
Patients undergoing surgery and adjuvant chemotherapy can still be candidates for APBI. Optimal visualization of the internal lumpectomy scar before implantation is mandatory. Cosmetic results may be slightly worse due to the interaction between chemotherapy and APBI, and technical refinements may be needed in this group of patients.
评估保乳手术、辅助化疗及高剂量率近距离放疗的延迟加速部分乳腺照射（APBI）的可行性及中期结果。
2000年至2007年期间，共26例中位年龄54岁的患者接受了保乳手术，随后进行辅助化疗及单纯高剂量率近距离放疗。纳入标准遵循放射治疗肿瘤学组95-17试验指南。肿瘤床在手术时（n = 2）或近距离放疗前（n = 24）进行标记。近距离放疗程序在术后中位22周进行。中位14根近距离放疗导管放置在三到四个平行平面。临床靶体积（CTV90）的处方剂量为34.0 Gy，分10次，每日两次，连续5天给予。
中位随访53个月（范围6.8 - 81个月）后，分别在10例（38.4%）患者和3例（11.5%）患者中观察到放射治疗肿瘤学组1 - 2级事件和3级事件。未观察到4 - 5级事件。根据Wazer标准，患者将其美容效果评为优秀（37.5%）、良好（50.0%）、中等（8%）或差（4%）。6年精算局部、乳腺其他部位及远处控制率分别为100%、96.2%和96.2%。6年无病生存率和总生存率分别为92.3%和96.2%。
接受手术和辅助化疗的患者仍可作为APBI的候选者。植入前对乳房肿块切除内部瘢痕的最佳可视化是必需的。由于化疗与APBI之间的相互作用，美容效果可能略差，这组患者可能需要技术改进。
