Radiation Oncology Department, Hospital Central de la Defensa Gómez-Ulla, C/Glorieta del Ejército s/n, Madrid, Spain.
Clin Transl Oncol. 2012 Dec;14(12):953-60. doi: 10.1007/s12094-012-0881-4. Epub 2012 Sep 14.
The essential issue in conservative treatment is the quality in breast preservation. When risk factors for local relapse exist, a tumour bed boost is required, but the boost choice remains controversial. Prospectively, we studied long-term toxicity, cosmetic outcome and prognostic factors.
After conservative treatment, 115 patients received a single dose of 7 Gy HDR-brachytherapy (HDR-BT) boost between June 1996 and December 2005. Late toxicity was assessed using the LENT-SOMA scale. For esthetic assessment, a subjective scale was used for patients and a modified Fehlauer scale for physicians. Mean age was 56.6 years. Invasive ductal carcinoma (78 %) and lumpectomy (60 %) were predominantly reported. 48 % received chemotherapy (CT).
Regarding toxicity, 39 % of patients reported breast pain, 75 % fibrosis, 56 % telangiectasias, 19 % lymphoedema, and 51 % retraction/atrophy. Concerning management, 22 % of patients with pain and 45 % with lymphoedema were treated. The esthetic result was found satisfactory by 96 % of the patients and 85 % of the physicians. Fibrosis was influenced by CT and a larger irradiated volume and telangiectasias by a greater implant volume.
HDR-BT boost shows good cosmetic effects with acceptable toxicity. Patients overestimate the esthetic outcome. LENT/SOMA is useful to assess chronic toxicity.
保守治疗的关键问题是乳房保留的质量。当存在局部复发的危险因素时，需要进行肿瘤床加量放疗，但加量放疗的选择仍存在争议。前瞻性地，我们研究了长期毒性、美容效果和预后因素。
在接受保守治疗后，115 例患者于 1996 年 6 月至 2005 年 12 月期间接受了单次 7 Gy 高剂量率近距离放疗（HDR-BT）加量放疗。采用 LENT-SOMA 量表评估迟发性毒性。为了评估美容效果，使用了患者主观量表和改良的 Fehlauer 量表。平均年龄为 56.6 岁。报告的浸润性导管癌（78%）和保乳术（60%）为主。48%的患者接受了化疗（CT）。
在毒性方面，39%的患者报告乳房疼痛，75%的患者出现纤维化，56%的患者出现毛细血管扩张，19%的患者出现淋巴水肿，51%的患者出现收缩/萎缩。在管理方面，22%的疼痛患者和 45%的淋巴水肿患者接受了治疗。96%的患者和 85%的医生认为美容效果满意。纤维化与 CT 和更大的照射体积有关，毛细血管扩张与更大的植入物体积有关。
HDR-BT 加量放疗显示出良好的美容效果和可接受的毒性。患者高估了美容效果。LENT/SOMA 可用于评估慢性毒性。
