Department of Radiation Oncology, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany.
Int J Radiat Oncol Biol Phys. 2010 Jul 15;77(4):1140-5. doi: 10.1016/j.ijrobp.2009.06.008. Epub 2009 Oct 14.
To determine the frequency and volume of seroma after breast-conserving surgery (BCS) with or without intraoperative radiotherapy (IORT).
Seventy-one patients with 73 breast cancers (IORT group) treated with IORT (20 Gy Intrabeam) as a boost during BCS were compared with 86 patients with 88 breast tumors (NO-IORT group) treated without IORT. Clinical examination and measurement of seroma volume on treatment-planning CT (CT-seroma) was done at median interval of 35 days after BCS.
Seroma were found on palpation in 37 patients (23%) and on CT in 105 patients (65%; median volume, 26.3 mL). Interval between BCS and CT was significantly shorter in patients with palpable seroma (median, 33 days) or CT-seroma (33 days) compared with those with no palpable seroma (36.5 days; p = 0.027) or CT-seroma (52 days, p < 0.001). The rate of palpable seroma was not different (IORT n = 17, 23%; NO-IORT n = 20, 23%; p = 0.933), whereas fewer patients required puncture in the IORT group [3 (4%) vs. 10 (11%)]. In contrast, more patients showed CT-seroma after IORT (IORT n = 59, 81%; NO-IORT n = 46, 52%; p < 0.001). The interval between BCS and CT was significantly shorter in patients with IORT as compared with the NO-IORT patients (median, 33 days vs. 41.5 days; p = 0.036).
Intraoperative radiotherapy with low-kilovoltage X-rays during BCS is not associated with an increased rate of palpable seroma or seroma requiring treatment. The rate of seroma formation on CT was higher after IORT compared with the NO-IORT group, which might be because of the shorter interval between BCS and CT.
确定保乳手术后（BCS）是否联合术中放疗（IORT）的血清肿发生频率和体积。
71 例 73 例乳腺癌患者（IORT 组）在 BCS 期间接受 IORT（20 Gy Intrabeam）作为辅助治疗，与 86 例 88 例乳腺肿瘤患者（NO-IORT 组）未接受 IORT 治疗进行比较。BCS 后中位间隔 35 天进行临床检查和治疗计划 CT（CT-血清肿）测量。
37 例（23%）患者触诊发现血清肿，105 例（65%）患者 CT 发现血清肿（中位数体积 26.3mL）。与无触诊血清肿（中位数 36.5 天）或 CT-血清肿（52 天，p<0.001）患者相比，有触诊血清肿（中位数 33 天）或 CT-血清肿（33 天）患者 BCS 与 CT 之间的间隔明显缩短。IORT 组和 NO-IORT 组触诊血清肿发生率无差异（IORT n=17，23%；NO-IORT n=20，23%；p=0.933），但 IORT 组需要穿刺的患者较少[3（4%）vs.10（11%）]。相比之下，IORT 组有更多的患者 CT 显示血清肿（IORT n=59，81%；NO-IORT n=46，52%；p<0.001）。与 NO-IORT 患者相比，IORT 患者 BCS 与 CT 之间的间隔明显缩短（中位数 33 天 vs.41.5 天；p=0.036）。
在 BCS 期间使用低千伏 X 射线进行术中放疗不会增加触诊血清肿或需要治疗的血清肿的发生率。与 NO-IORT 组相比，IORT 组 CT 上血清肿形成率更高，这可能是因为 BCS 与 CT 之间的间隔更短。
