Dragun Anthony E, Harper Jennifer L, Olyejar S Eric, Zunzunegui Raul G, Wazer David E
Department of Radiation Oncology, University of Louisville School of Medicine, Louisville, KY 40202, USA.
Brachytherapy. 2011 Mar-Apr;10(2):121-7. doi: 10.1016/j.brachy.2010.05.001. Epub 2010 Aug 1.
To analyze toxicity and cosmesis in patients with collagen vascular disease (CVD) treated with accelerated partial breast irradiation (APBI) via high-dose-rate (HDR) brachytherapy.
This is a pooled analysis of patients with early stage and in situ breast cancer with CVD treated with adjuvant multicatheter or balloon brachytherapy. Physicians at multiple institutions were asked to review their experience and report data regarding toxicity and cosmesis in patients with CVD. All patients fit American Society of Breast Surgeons recommendations for APBI and were treated with HDR brachytherapy with ≥ 3 months followup.
Nine cases from five institutions are the subject of this analysis. The median patient age was 54 years and median followup was 31 months. All patients had documented history and active signs/symptoms of rheumatoid arthritis, systemic lupus erythematosis, psoriatic arthritis, or scleroderma. All patients had received medical therapy for CVD in the past, and 78% were under active treatment at the time of brachytherapy. All the patients were treated with multicatheter or balloon (MammoSite [Hologic, Inc., Marlboro, MA], MammoSite ML [Hologic, Inc., Marlboro, MA], or Contura [Senorx, Irvine, CA]) brachytherapy with a median volume of 45.5 cc and a median skin distance of 7.5mm. Acute toxicity included Grade 1 skin erythema (5) and catheter-site wound dehiscence (1). Late toxicity included seroma (5), induration (5), pain (2), telangectasia (2), and superficial infection (1). Cosmesis was excellent or good for all the patients.
Women with CVD have a toxicity and cosmesis profile consistent with other APBI series. Although confirmatory data is needed, it may not be necessary to exclude these patients from clinical trials of APBI.
分析接受高剂量率（HDR）近距离放射治疗的加速部分乳腺照射（APBI）的胶原血管病（CVD）患者的毒性和美容效果。
这是一项对接受辅助多导管或球囊近距离放射治疗的早期和原位乳腺癌合并CVD患者的汇总分析。多个机构的医生被要求回顾他们的经验并报告有关CVD患者毒性和美容效果的数据。所有患者均符合美国乳腺外科医生协会对APBI的建议，并接受了HDR近距离放射治疗，随访时间≥3个月。
本分析的对象是来自五个机构的9例患者。患者中位年龄为54岁，中位随访时间为31个月。所有患者均有类风湿关节炎、系统性红斑狼疮、银屑病关节炎或硬皮病的记录病史和活动体征/症状。所有患者过去均接受过CVD的药物治疗，78%在近距离放射治疗时正在接受积极治疗。所有患者均接受多导管或球囊（MammoSite [Hologic公司，马萨诸塞州马尔伯勒]、MammoSite ML [Hologic公司，马萨诸塞州马尔伯勒]或Contura [Senorx公司，加利福尼亚州欧文]）近距离放射治疗，中位体积为45.5 cc，中位皮肤距离为7.5mm。急性毒性包括1级皮肤红斑（5例）和导管部位伤口裂开（1例）。晚期毒性包括血清肿（5例）、硬结（5例）、疼痛（2例）、毛细血管扩张（2例）和浅表感染（1例）。所有患者的美容效果均为优或良。
CVD女性患者的毒性和美容效果与其他APBI系列一致。尽管需要确证数据，但可能没有必要将这些患者排除在APBI临床试验之外。
