Department of Radiation Oncology, Tufts Medical Center, Tufts University School of Medicine, Boston, MA, USA.
Int J Radiat Oncol Biol Phys. 2012 Aug 1;83(5):1374-80. doi: 10.1016/j.ijrobp.2011.10.016. Epub 2011 Dec 29.
To evaluate the feasibility, implementation, and early results of noninvasive breast brachytherapy (NIBB) for tumor bed boost with whole breast radiation therapy (WBRT).
NIBB is a commercially available (AccuBoost, Billerica, MA) mammography-based, brachytherapy system in which the treatment applicators are centered on the planning target volume (PTV) to direct (192)Ir emissions along orthogonal axes. A privacy-encrypted online data registry collected information from 8 independent academic and community-based institutions. Data were from 146 consecutive women with early-stage breast cancer after lumpectomy and WBRT receiving boost with NIBB between July 2007 and March 2010. Toxicity and cosmesis were graded according to the Common Toxicity Criteria (v. 3.0) and the Harvard scale. Median follow-up was 6 months (1-39 months).
Grade 1-2 skin toxicity was observed in 64%, 48%, and 21% during the acute (1-3 weeks), intermediate (4-26 weeks), and late-intermediate (>26 weeks) periods. There was no Grade 4 toxicity. At 6 months, for the entire cohort, cosmesis was excellent/good in 62%/38%. The subset receiving NIBB before WBRT had cosmetic scores of 32% and 63%, whereas during WBRT, 58% and 37% were rated as excellent and good, respectively. Breast compression was scored as "uncomfortable" in 12%, 29%, and 59% when NIBB was delivered before, during, or after WBRT. For each patient, the fraction-to-fraction variability in PTV was low. Skin flash was associated with a higher proportion of excellent cosmesis (58% vs. 42%) relative to having the applicator all within breast tissue.
These data indicate that NIBB is feasible and can be consistently implemented in a broad array of practice settings. Preliminary evaluation suggests that NIBB is associated with acceptably mild normal tissue toxicity and favorable early cosmesis. The application of NIBB before WBRT may be associated with better patient tolerance at the expense of less favorable cosmetic outcome.
评估非侵入性乳房近距离放射治疗（NIBB）用于全乳放射治疗（WBRT）后肿瘤床加量的可行性、实施情况和早期结果。
NIBB 是一种商业上可获得的（AccuBoost，Billerica，MA）基于乳腺摄影的近距离放射治疗系统，其中治疗施源器以计划靶区（PTV）为中心，沿正交轴引导（192）Ir 发射。一个隐私加密的在线数据登记处从 2007 年 7 月至 2010 年 3 月期间在 8 个独立的学术和社区机构接受 NIBB 加量的 146 例早期乳腺癌保乳术后妇女中收集信息。毒性和美容效果根据通用毒性标准（v.3.0）和哈佛量表进行分级。中位随访时间为 6 个月（1-39 个月）。
急性（1-3 周）、中期（4-26 周）和晚期中期（>26 周）期间，分别有 64%、48%和 21%的患者出现 1-2 级皮肤毒性。无 4 级毒性。在 6 个月时，整个队列的美容效果为优秀/良好的分别为 62%/38%。在接受 WBRT 前接受 NIBB 的亚组中，美容评分分别为 32%和 63%，而在接受 WBRT 期间，分别有 58%和 37%被评为优秀和良好。当 NIBB 在 WBRT 前、中或后进行时，乳房压缩的评分分别为“不舒服”的有 12%、29%和 59%。对于每个患者，PTV 的分次间变异性较低。与施源器完全位于乳房组织内相比，皮肤闪光与更高比例的优秀美容效果（58% vs. 42%）相关。
这些数据表明 NIBB 是可行的，可以在广泛的实践环境中一致实施。初步评估表明，NIBB 与可接受的轻度正常组织毒性和良好的早期美容效果相关。在 WBRT 前应用 NIBB 可能会增加患者的耐受性，但代价是美容效果不太理想。
