Department of Radiation Oncology, University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany.
Ann Surg Oncol. 2010 Oct;17 Suppl 3:352-8. doi: 10.1245/s10434-010-1265-z. Epub 2010 Sep 19.
Intraoperative radiotherapy (IORT) during breast-conserving surgery as a boost followed by whole-breast radiotherapy is increasingly used.
Between February 2002 and December 2008, a total of 197 patients were treated with IORT as a boost (20 Gy, 50 kV x-rays; Intrabeam System, Carl Zeiss Surgical, Oberkochen, Germany) during breast-conserving surgery, followed by whole-breast radiotherapy (46-50 Gy). Systemic therapy was provided according to the St. Gallen consensus. Patients were recalled every 6-12 months for follow-up. Findings were scored according to the LENT-SOMA scale.
Median age was 61.8 (range 30-84) years, and median follow-up was 37 (range 5-91) months. There were T1, T2, and Tx tumors in 129, 67, and 1 patients, respectively, and N0, N1, N2, and N3 disease in 144, 36, 15, and 2 patients, respectively. Until December 2009, 5 local invasive relapses, 1 local ductal carcinoma-in-situ, 1 axillary relapse, 6 secondary cancers, and 11 distant metastases were seen, resulting in a 5-year disease-free survival of 81.0% and an overall survival of 91.3%. Local relapse-free survival (invasive cancers) at 3 and 5 years was 97.0%. After a follow-up of 5 years (n =58), only 8 patients (13.8%) had chronic skin toxicities, and 2 patients (3.4%) had a marked increase in density (fibrosis III), while 62.0% had no/barely palpable fibrosis 0-I. Other toxicities observed included severe pain (n = 4, 6.9%), retraction (n =17, 29.3%), edema of the breast (n =1, 1.7%), and lymphedema in general (n =2, 3.4%).
After IORT as a tumor bed boost with low-kilovoltage x-rays followed by whole-breast radiotherapy, low local recurrence and chronic toxicity rates were seen after 5-year follow-up.
保乳手术后的术中放疗（IORT）作为辅助治疗，随后进行全乳放疗，这种治疗方法的应用越来越广泛。
在 2002 年 2 月至 2008 年 12 月期间，共有 197 例患者接受了 IORT 作为辅助治疗（20 Gy，50 kV X 射线；Intrabeam 系统，德国卡尔蔡司外科公司），在保乳手术后进行全乳放疗（46-50 Gy）。根据圣加仑共识提供系统治疗。患者每 6-12 个月进行一次随访。根据 LENT-SOMA 量表对发现进行评分。
中位年龄为 61.8 岁（范围 30-84 岁），中位随访时间为 37 个月（范围 5-91 个月）。T1、T2 和 Tx 肿瘤分别为 129、67 和 1 例，N0、N1、N2 和 N3 疾病分别为 144、36、15 和 2 例。截至 2009 年 12 月，共发生 5 例局部浸润性复发、1 例局部导管原位癌、1 例腋窝复发、6 例继发性癌症和 11 例远处转移，5 年无病生存率为 81.0%，总生存率为 91.3%。3 年和 5 年的局部无复发生存率（浸润性癌）为 97.0%。在 5 年的随访后（n=58），仅有 8 例患者（13.8%）出现慢性皮肤毒性，2 例患者（3.4%）出现明显的密度增加（纤维化 III），而 62.0%的患者无/仅轻度可触及纤维化 0-I。观察到的其他毒性包括严重疼痛（n=4，6.9%）、回缩（n=17，29.3%）、乳房水肿（n=1，1.7%）和一般淋巴水肿（n=2，3.4%）。
采用低千伏 X 射线进行肿瘤床加量 IORT 后，再进行全乳放疗，5 年随访后局部复发率和慢性毒性率较低。
