Bloom Elizabeth S, Kirsner Steve, Mason Bryan E, Nelson Chris L, Hunt Kelly K, Baumann Donald P, Gifford Kent A
Division of Radiation Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, TX 77081, USA.
Brachytherapy. 2011 May-Jun;10(3):178-83. doi: 10.1016/j.brachy.2010.06.008. Epub 2010 Aug 17.
Accelerated partial breast irradiation (APBI) has gained popularity as an alternative to adjuvant whole breast irradiation; however, owing to limitations of delivery devices for brachytherapy, APBI has not been a suitable option for all the patients. This report evaluates APBI using the strut-adjusted volume implant (SAVI) single-entry catheter to deliver brachytherapy for breast cancer in the setting of an augmented breast.
The patient previously had placed bilateral subpectoral saline implants; stereotactic core biopsy revealed estrogen receptor- and progesterone receptor-positive ductal carcinoma in situ of intermediate nuclear grade. The patient underwent needle-localized segmental mastectomy of her left breast; pathologic specimen revealed no residual malignancy. An SAVI 8-1 device was placed within the segmental resection cavity. Treatment consisted of 3.4 Gy delivered twice a day for 5 days for a total dose of 34 Gy. Treatments were delivered with a high-dose-rate (192)Ir remote afterloader.
Conformance of the device to the lumpectomy cavity was excellent at 99.2%. Dosimetric values of percentage of the planning target volume for evaluation receiving 90% of the prescribed dose, percentage of the planning target volume for evaluation receiving 95% of the prescribed dose, volume receiving 150% of the prescribed dose, and volume receiving 200% of the prescribed dose were 97.1%, 94.6%, 22.7 cc, and 11.6 cc, respectively. Maximum skin dose was 115% of the prescribed dose. The patient tolerated treatment well with excellent cosmetic results, and limited acute and late toxicity at 8 weeks and 6 months, respectively.
Breast augmentation should not be an exclusion criterion for the option of APBI. The SAVI single-entry catheter is another option to successfully complete APBI using brachytherapy for breast cancer in the setting of an augmented breast.
加速部分乳腺照射（APBI）作为辅助性全乳照射的替代方法已越来越受欢迎；然而，由于近距离放射治疗输送设备的局限性，APBI并非适用于所有患者。本报告评估了使用支柱调整体积植入物（SAVI）单入口导管在隆乳情况下为乳腺癌进行近距离放射治疗的APBI。
该患者先前已植入双侧胸大肌下盐水植入物；立体定向核心活检显示为雌激素受体和孕激素受体阳性的中等级别核原位导管癌。患者接受了左乳针定位区段乳房切除术；病理标本显示无残留恶性肿瘤。将一个SAVI 8-1装置放置在区段切除腔内。治疗包括每天两次给予3.4 Gy，共5天，总剂量为34 Gy。治疗使用高剂量率（192）铱遥控后装治疗机进行。
该装置与乳房肿瘤切除腔的贴合度极佳，为99.2%。接受90%处方剂量的评估计划靶体积百分比、接受95%处方剂量的评估计划靶体积百分比、接受150%处方剂量的体积以及接受200%处方剂量的体积的剂量学值分别为97.1%、94.6%、22.7 cc和11.6 cc。最大皮肤剂量为处方剂量的115%。患者对治疗耐受性良好，美容效果极佳，在8周和6个月时分别有有限的急性和晚期毒性。
隆乳不应成为APBI选择的排除标准。SAVI单入口导管是在隆乳情况下使用近距离放射治疗成功完成乳腺癌APBI的另一种选择。
