Yoshida Ken, Nose Takayuki, Masuda Norikazu, Yamazaki Hideya, Kotsuma Tadayuki, Yoshida Mineo, Yamamura Jun, Masuda Hiroko, Shin Eisei, Nakaba Hiroyuki, Komoike Yoshifumi, Tokuda Yukiko, Takeda Masashi, Kuriyama Keiko
Department of Radiology, National Hospital Organization Osaka National Hospital, 2-1-14 Hoenzaka, Chuo-ku, Osaka, Osaka, 540-0006, Japan.
Breast Cancer. 2009;16(2):105-12. doi: 10.1007/s12282-008-0067-7. Epub 2008 Sep 20.
To investigate the feasibility of accelerated partial breast irradiation (APBI) for Japanese patients, we started high-dose-rate interstitial brachytherapy (HDR-ISBT) as monotherapy after breast-conserving surgery (BCS).
We implanted 45 Tis-2 breast cancer patients at National Hospital Organization Osaka National Hospital between June 2002 and June 2006. Our eligibility criteria were broader than the ones used previously in western countries. We included margin-positive cases and younger patients (median age: 44; range: 26-68) to adapt the criteria for Japanese women. Total prescribed doses were 36-42 Gy in six to seven fractions, and the volumes encompassed by 100% prescribed dose (V100) were 38.5-315.1 cc. Fifteen patients received chemotherapy.
Treatment could be completed for all patients. Two local failures (4%) and two distant metastases were observed, while one patient died of liver metastasis. Seven wound complications, four with and three without infection, and two rib fractures occurred. The significant risk factors for wound complications were non-administration of prophylactic antibiotics during ISBT (P < 0.01), open cavity implant (P < 0.05), large V100 (P < 0.01), V150 (P < 0.05), and V200 (P < 0.05).
APBI after BCS for Japanese women with relatively small breasts was well tolerated, but special care should be taken with treatment technique.
为研究加速部分乳腺照射（APBI）对日本患者的可行性，我们在保乳手术（BCS）后开始将高剂量率组织间近距离放疗（HDR-ISBT）作为单一疗法。
2002年6月至2006年6月期间，我们在国立医院组织大阪国立医院为45例Tis-2期乳腺癌患者植入了放射源。我们的入选标准比西方国家先前使用的标准更为宽泛。为适应日本女性的标准，我们纳入了切缘阳性病例和年轻患者（中位年龄：44岁；范围：26 - 68岁）。总处方剂量为36 - 42 Gy，分六至七次给予，100%处方剂量所涵盖的体积（V100）为38.5 - 315.1 cc。15例患者接受了化疗。
所有患者均完成了治疗。观察到2例局部复发（4%）和2例远处转移，1例患者死于肝转移。发生了7例伤口并发症，其中4例伴有感染，3例无感染，以及2例肋骨骨折。伤口并发症的显著危险因素包括在组织间近距离放疗期间未使用预防性抗生素（P < 0.01）、开放腔隙植入（P < 0.05）、V100较大（P < 0.01）、V150（P < 0.05）和V200（P < 0.05）。
对于乳房相对较小的日本女性，保乳手术后进行APBI耐受性良好，但治疗技术应特别注意。
