Oncology Centre, Multiscan & Pardubice Regional Hospital, Pardubice, Czech Republic.
Neoplasma. 2012;59(5):494-9. doi: 10.4149/neo_2012_063.
Intraoperative placement of catheters in the tumor bed during breast-conserving surgery (BCS) enables postponed targeted boost irradiation in high risk breast cancer patients. Twenty-three patients with high risk breast cancer underwent neoadjuvant chemotherapy and multifractionated perioperative brachytherapy as a boost to the tumor bed using three-dimensional (3D) CT-based planning. Plastic catheters for brachytherapy were implanted during surgery and targeted irradiation was delivered in the course of 2-3 weeks. Acute and late toxicities were scored according to the RTOG Common Toxicity Criteria. Cosmetic outcomes were assessed using the Harvard criteria. No major perioperative complications were recorded. Circumscribed wound infection occurred in one patient (4.3%). Only 3 patients (13%) experienced acute skin toxicity Grade 1. We observed no teleangiectasias or pigmentations. The cosmetic outcome at last follow-up visit was rated as excellent/good, in 82.6%, fair, in 13% and poor in 4.4% of patients, respectively. There was no evidence of disease recurrence after median follow-up of 43. 4 months. Systematic integration of the perioperative fractionated 3D CT-based HDR brachytherapy as a boost for patients with breast cancer after BCS is feasible and seems safe. It might be beneficial especially for women with high risk of local recurrence.
术中在保乳手术（BCS）的肿瘤床内放置导管，使高危乳腺癌患者能够进行延迟靶向增强放疗。23 例高危乳腺癌患者接受新辅助化疗和多分割围手术期近距离放疗，作为肿瘤床的三维（3D）CT 基于计划的增强。术中植入用于近距离放疗的塑料导管，并在 2-3 周内进行靶向照射。根据 RTOG 常见毒性标准对急性和迟发性毒性进行评分。使用哈佛标准评估美容结果。无主要围手术期并发症记录。1 例患者（4.3%）发生局限性伤口感染。仅 3 例患者（13%）出现 1 级急性皮肤毒性。我们未观察到血管扩张或色素沉着。最后一次随访时的美容效果分别为 82.6%的优秀/良好、13%的一般和 4.4%的较差。中位随访 43.4 个月后无疾病复发证据。在 BCS 后对乳腺癌患者进行系统整合的围手术期分割 3D CT 基于 HDR 近距离放疗作为增强是可行的，似乎是安全的。它可能对局部复发风险较高的女性特别有益。
