Cancer Center of Irvine, Irvine, California, USA.
Breast J. 2010 Nov-Dec;16(6):581-6. doi: 10.1111/j.1524-4741.2010.00977.x.
The objective of this study was to report our single-institution results with MammoSite and multi-catheter brachytherapy. Between February 2003 and January 2009, 173 women with unifocal pathological Tis, T1, or T2 (up to 30 mm), N0 or N1 carcinomas of the breast were treated with post-lumpectomy brachytherapy to 34 Gy in 10 fractions over 5-10 days. We treated 137 patients with MammoSite single-lumen balloon brachytherapy, and 36 patients with multi-catheter brachytherapy. Patients with small and/or nonspherical lumpectomy cavities were usually treated with multi-catheter brachytherapy using 4-12 interstitial catheters. Median follow-up was 33 months. Three-year ipsilateral breast tumor control, disease-free, and overall survival rates for MammoSite brachytherapy were 100%, 100%, and 99%, respectively. Similar rates were obtained with multi-catheter brachytherapy. Minimum distances from the planning target volume for plan evaluation to a rib were 10 ± 8 mm (mean ± standard deviation) and 8 ± 4 mm (mean ± standard deviation) for MammoSite brachytherapy and multi-catheter brachytherapy, respectively (p = 0.48). Maximum rib doses were 101 ± 14% (mean ± standard deviation) and 74 ± 10% (mean ± standard deviation) of the prescribed dose for MammoSite brachytherapy and multi-catheter brachytherapy, respectively (p = 0.001). Multi-catheter brachytherapy results in more conformal radiation dose delivery and a significantly lower rib dose than MammoSite single-lumen brachytherapy. Long-term follow-up is needed to determine if the delivery of a lower radiation dose to the ribs will translate into a lower incidence of rib pain and fractures.
本研究旨在报告我们应用 MammoSite 和多导管近距离放疗的单中心结果。2003 年 2 月至 2009 年 1 月，对 173 例单病灶病理 Tis、T1 或 T2（最大 30mm）、N0 或 N1 乳腺癌患者行保乳术后放疗，采用 10 次 5-10 天内 34Gy 的分割剂量。137 例患者接受 MammoSite 单腔球囊近距离放疗，36 例患者接受多导管近距离放疗。小肿瘤和/或非球形乳房切除术腔的患者通常采用 4-12 根间质导管的多导管近距离放疗。中位随访时间为 33 个月。MammoSite 近距离放疗的 3 年同侧乳腺肿瘤控制率、无病生存率和总生存率分别为 100%、100%和 99%。多导管近距离放疗也获得了类似的结果。MammoSite 近距离放疗和多导管近距离放疗的计划评估时计划靶区与肋骨的最小距离分别为 10 ± 8mm（均值 ± 标准差）和 8 ± 4mm（均值 ± 标准差）（p = 0.48）。最大肋骨剂量分别为 101 ± 14%（均值 ± 标准差）和 74 ± 10%（均值 ± 标准差），为处方剂量的 MammoSite 近距离放疗和多导管近距离放疗，分别（p = 0.001）。多导管近距离放疗的结果是更符合适形辐射剂量分布，肋骨剂量明显低于 MammoSite 单腔近距离放疗。需要长期随访以确定肋骨接受较低的辐射剂量是否会降低肋骨疼痛和骨折的发生率。
