Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania.
Department of Radiation Oncology, University of Maryland, Baltimore, Maryland.
Pract Radiat Oncol. 2013 Jan-Mar;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 radiation therapy (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 or ≥D cup) were treated with BCT using either 3-dimensional conformal radiation therapy (3DCRT) or intensity modulated radiation therapy (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 with 70% of patients not in a bra (P = .003). On multivariate analysis significant predictors of grade 2 or 3 skin toxicity included the use of 3DCRT instead of IMRT (odds ratio, 3.9; 95% confidence interval, 1.8-8.5) and the use of a bra (odds ratio, 5.5; 95% confidence interval, 1.6-18.8). For left-sided patients, the use of a bra was associated with a volume of heart in the treatment fields decreased by 63.4% (P = .002), a volume of left lung decreased by 18.5% (P = .25), and chest wall separation decreased by a mean of 1 cm (P = .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射治疗（BCT）的女性中，乳房较大会导致放射模拟、计划和患者治疗出现特殊问题，包括皮肤毒性增加。我们报告了在乳房较大的女性中使用胸罩进行放射治疗的经验，以及其对急性毒性和心肺剂量学的影响。
2001 年至 2006 年，246 例连续的乳房较大的女性（胸罩尺寸≥38 或≥D 罩杯）接受了 3 维适形放射治疗（3DCRT）或调强放射治疗（IMRT）的 BCT。在 58 例中，根据医生的判断，在模拟和治疗期间使用了定制胸罩。终点是急性放射性皮炎和 12 例左侧乳腺癌患者计划使用和不使用胸罩的心肺体积的剂量学比较。
大多数急性皮肤毒性为 2 级，使用胸罩的患者中有 90%经历了这种毒性，而不使用胸罩的患者中有 70%经历了这种毒性（P=0.003）。多变量分析显示，2 级或 3 级皮肤毒性的显著预测因素包括使用 3DCRT 而不是 IMRT（优势比，3.9；95%置信区间，1.8-8.5）和使用胸罩（优势比，5.5；95%置信区间，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）和胸壁分离减少 1 厘米（P=0.03）相关。
在乳房较大的女性中使用胸罩来增加乳房形状和位置是俯卧位的替代方法，与胸壁分离减少和治疗野内心脏体积减少相关。
