Keller Lanea, Cohen Randi, Sopka Dennis M, Li Tianyu, Li Linna, Anderson Penny R, Fowble Barbara L, Freedman Gary M
Radiation Oncology, Fox Chase Cancer Center, Philadelphia, PA.
Pract Radiat Oncol. 2013;3(1):9-15. doi: 10.1016/j.prro.2012.07.003. Epub 2013 Jan 5.
Large breast size presents special problems during radiation simulation, planning and patient treatment, including increased skin toxicity, in women undergoing breast-conserving surgery and radiotherapy (BCT). We report our experience using a bra during radiation in large-breasted women and its effect on acute toxicity and heart and lung dosimetry.
From 2001 to 2006, 246 consecutive large-breasted women (bra size ≥ 38 and/or ≥ D cup) were treated with BCT using either 3D conformal (3D-CRT) or Intensity Modulated Radiation (IMRT). In 58 cases, at the physicians' discretion, a custom-fit bra was used during simulation and treatment. Endpoints were acute radiation dermatitis, and dosimetric comparison of heart and lung volumes in a subgroup of 12 left-sided breast cancer patients planned with and without a bra.
The majority of acute skin toxicities were grade 2 and were experienced by 90% of patients in a bra compared to 70% of patients not in a bra (p=0.003). On multivariate analysis significant predictors of grade 2/3 skin toxicity included 3D-CRT instead of IMRT (OR=3.9, 95% CI:1.8-8.5) and the use of a bra (OR=5.5, 95% CI:1.6-18.8). For left-sided patients, use of a bra was associated with a volume of heart in the treatment fields decreased by 63.4% (p=0.002), a volume of left lung decreased by 18.5% (p=0.25), and chest wall separation decreased by a mean of 1 cm (p=0.03).
The use of a bra to augment breast shape and position in large-breasted women is an alternative to prone positioning and associated with reduced chest wall separation and reduced heart volume within the treatment field.
在接受保乳手术和放疗（BCT）的女性中，乳房体积较大在放射模拟、计划制定和患者治疗过程中会带来特殊问题，包括皮肤毒性增加。我们报告了在乳房体积较大的女性放疗期间使用胸罩的经验及其对急性毒性以及心脏和肺部剂量测定的影响。
2001年至2006年，246例连续的乳房体积较大的女性（胸罩尺寸≥38码和/或≥D罩杯）接受了三维适形放疗（3D-CRT）或调强放疗（IMRT）的保乳手术治疗。在58例病例中，根据医生的判断，在模拟和治疗期间使用了定制胸罩。观察终点为急性放射性皮炎，以及在12例左侧乳腺癌患者的亚组中，有胸罩和无胸罩计划下心脏和肺部体积的剂量学比较。
大多数急性皮肤毒性为2级，使用胸罩的患者中有90%出现，而未使用胸罩的患者中有70%出现（p=0.003）。多因素分析显示，2/3级皮肤毒性的显著预测因素包括使用3D-CRT而非IMRT（比值比[OR]=3.9，95%可信区间[CI]：1.8-8.5）以及使用胸罩（OR=5.5，95%CI：1.6-18.8）。对于左侧患者，使用胸罩与治疗野中心脏体积减少63.4%（p=0.002）、左肺体积减少18.5%（p=0.25）以及胸壁间距平均减少1厘米（p=0.03）相关。
在乳房体积较大的女性中使用胸罩来改善乳房形状和位置，是俯卧位的一种替代方法，且与胸壁间距减小和治疗野中心脏体积减小相关。
