Trombetta Mark, Hall Michael, Julian Thomas B
Department of Radiation Oncology, Allegheny General Hospital, Pittsburgh, PA; Department of Radiation Oncology, Temple University School of Medicine, Pittsburgh Campus, Pittsburgh, PA.
Department of Radiation Oncology, Allegheny General Hospital, Pittsburgh, PA.
Brachytherapy. 2014 Sep-Oct;13(5):488-92. doi: 10.1016/j.brachy.2014.05.017. Epub 2014 Jun 18.
To report our long-term experience with balloon brachytherapy in retreatment of the breast after ipsilateral breast tumor recurrence.
Between March 2004 and June 2012, 18 patients previously treated with external beam radiotherapy were retreated using either the MammoSite (Hologic Corporation, Marlborough, MA), MammoSite ML (Hologic Corporation), or the Contura (Bard Peripheral Vascular, Inc., Tempe, AZ) brachytherapy devices. Sixteen patients were treated for an ipsilateral breast tumor recurrence after breast conservation surgery and postoperative irradiation (11 with infiltrating ductal carcinoma [IDC] and 6 with ductal carcinoma in situ [DCIS]), whereas 2 patients developed an in-field breast cancer likely associated with Hodgkin disease mantle irradiation (27 and 17 years prior, respectively). The recurrent histology of seven was IDC, with seven others recurring as DCIS, three as a combination of IDC/DCIS, and one as infiltrating lobular carcinoma. All patients received a twice-daily tumor dose of 3400 cGy at 340 cGy per fraction. Acute and chronic side effects were graded by the Common Terminology Criteria for Adverse Events, version 4.0. Cosmesis was graded by both the Harvard Cosmesis Scale and the Allegheny General Modification of the Harvard Scale.
With a mean of followup of 39.6 months, only 2 patients developed a local recurrence. One patient developed an inflammatory recurrence from what was identified as a moderately differentiated T1N0M0 estrogen receptor-positive recurrence, and the second developed a recurrence immediately adjacent to the implant site. Both patients were treated locally by salvage mastectomy. The patient who developed an inflammatory recurrence rapidly developed visceral metastases including brain lesions and succumbed to her progressive disease. The second patient was successfully salvaged with uncomplicated mastectomy, and she survives to this date. One patient developed a chronic abscess in the sinus tract of the balloon, which required mastectomy, and one developed a post-treatment infection in the catheter tract, which was successfully treated with oral antibiotics. Cosmesis as graded by the Harvard cosmesis criteria and the Allegheny General Modification Score diminished one grade in only 2 patients. All other patients had stable cosmetic scores.
Use of balloon brachytherapy devices in the treatment of the previously irradiated breast is feasible and may provide adequate local control and acceptable cosmesis in carefully selected patients. Further study and refinement of this therapy is required for more definitive results.
报告我们在同侧乳腺肿瘤复发后对乳腺进行再治疗时使用球囊近距离放射治疗的长期经验。
2004年3月至2012年6月期间，18例先前接受过外照射放疗的患者使用MammoSite（Hologic公司，马萨诸塞州马尔伯勒）、MammoSite ML（Hologic公司）或Contura（巴德外周血管公司，亚利桑那州坦佩）近距离放射治疗设备进行再治疗。16例患者在保乳手术和术后放疗后发生同侧乳腺肿瘤复发（11例为浸润性导管癌[IDC]，6例为导管原位癌[DCIS]），而2例患者发生了可能与霍奇金病斗篷野照射相关的野内乳腺癌（分别在27年和17年前）。复发组织学类型中，7例为IDC，7例为DCIS，3例为IDC/DCIS组合，1例为浸润性小叶癌。所有患者接受每日两次的肿瘤剂量，每次340 cGy，总剂量3400 cGy。急性和慢性副作用按照不良事件通用术语标准4.0版进行分级。美容效果按照哈佛美容量表和哈佛量表的阿勒格尼综合修订版进行分级。
平均随访39.6个月，仅2例患者出现局部复发。1例患者发生炎症性复发，病理为中度分化的T1N0M0雌激素受体阳性复发，另1例在植入部位紧邻处复发。2例患者均接受了挽救性乳房切除术。发生炎症性复发的患者迅速出现内脏转移，包括脑转移，最终因疾病进展死亡。第二例患者通过无并发症的乳房切除术成功挽救，至今存活。1例患者在球囊窦道发生慢性脓肿，需要进行乳房切除术，1例在导管通道发生治疗后感染，经口服抗生素成功治疗。按照哈佛美容标准和阿勒格尼综合修订评分，美容效果仅在2例患者中降低了一个等级。所有其他患者的美容评分稳定。
在先前接受过照射的乳腺治疗中使用球囊近距离放射治疗设备是可行的，在精心挑选的患者中可能提供足够的局部控制和可接受的美容效果。需要进一步研究和完善该治疗方法以获得更确切的结果。
