Polgár Csaba, Major Tibor
Department of Radiotherapy, National Institute of Oncology, Budapest, Hungary.
Int J Clin Oncol. 2009 Feb;14(1):7-24. doi: 10.1007/s10147-008-0867-y. Epub 2009 Feb 20.
Before the era of breast-conserving therapy, brachytherapy implants were used to treat large inoperable breast tumors. In later years, interstitial brachytherapy with rigid needles or multiple flexible catheters has been used to deliver an additional (boost) dose to the tumor bed after breast-conserving surgery and whole-breast irradiation. Reexcision followed by reirradiation using interstitial breast implants has also been implemented as an alternative to mastectomy to treat ipsilateral breast local recurrence after previous breast-conserving therapy. In the past two decades, the new concept of accelerated partial breast irradiation opened a new perspective for breast brachytherapy. The first technique utilized in early accelerated partial breast irradiation studies was multicatheter interstitial brachytherapy. Beyond classical interstitial brachytherapy, recently, new intracavitary applicators have been developed in the United States to decrease the existing barriers against the widespread use of multicatheter brachytherapy. Furthermore, interstitial low-dose-rate seed implants have also been implemented as an alternative for stepping-source multicatheter brachytherapy. In this article, we give an overview of the past achievements, current status, and future perspectives of breast brachytherapy.
在保乳治疗时代之前，近距离放射治疗植入物被用于治疗无法手术切除的大型乳腺肿瘤。近年来，在保乳手术和全乳照射后，使用刚性针或多个柔性导管进行间质近距离放射治疗，以向瘤床给予额外的（增强）剂量。在先前的保乳治疗后，采用间质乳腺植入物进行再切除并随后再照射，也已作为乳房切除术的替代方法，用于治疗同侧乳腺局部复发。在过去二十年中，加速部分乳腺照射的新概念为乳腺近距离放射治疗开辟了新的前景。早期加速部分乳腺照射研究中使用的第一种技术是多导管间质近距离放射治疗。除了传统的间质近距离放射治疗外，最近美国还开发了新的腔内施源器，以减少阻碍多导管近距离放射治疗广泛应用的现有障碍。此外，间质低剂量率种子植入物也已作为步进源多导管近距离放射治疗的替代方法得以应用。在本文中，我们概述了乳腺近距离放射治疗的过去成就、现状和未来前景。
