Akhtari Mani, Nitsch Paige L, Bass Barbara L, Teh Bin S
Department of Radiation Oncology, University of Texas Medical Branch, Galveston, TX.
Department of Radiation Oncology, The Methodist Hospital, Cancer Center and Research Institute, Houston, TX.
Brachytherapy. 2015 Mar-Apr;14(2):289-92. doi: 10.1016/j.brachy.2014.09.004. Epub 2014 Nov 5.
Accelerated partial breast irradiation is now an accepted component of breast-conserving therapy. However, data regarding long-term outcomes of patients treated with multilumen catheter systems who have existing breast implants are limited.
We report the treatment and outcome of our patient who had existing bilateral silicone subpectoral implants at the time of presentation. Ultrasound-guided core needle biopsy of the right breast showed infiltrating mucinous carcinoma. Right breast lumpectomy revealed an 8 mm area of infiltrating ductal carcinoma with mucinous features and nuclear grade 1. A 4-5 cm Contura (Bard Biopsy Systems, Tempe, AZ) device was placed, and she was treated over the course of 5 days twice daily to a dose of 34 Gy using a high-dose-rate iridium-192 source.
The planning target volume for evaluation was 73.9 cc. The percentage of the planning target volume for evaluation receiving 90%, 95%, and 100% of the prescribed dose was 99.9%, 99.3%, and 97.8%, respectively. The total implant volume was 234.5 cc and received a mean dose of 15.4 Gy and a maximum dose of 72.8 Gy. The percentage of implant volume receiving 50%, 75%, 100%, and 200% of the prescribed dose was 31.1%, 16.5%, 8.6%, 2.0%, and 0%, respectively. Maximum skin dose was 97% of the prescribed dose. With a followup of nearly 5 years, she continues to be cancer free with minimal late toxicities and good to excellent cosmetic outcome.
Accelerated partial breast irradiation using a multilumen balloon applicator in patients with existing breast implants can safely be performed with excellent long-term cosmetic outcome. Further studies are needed to establish the absolute dosimetric tolerance of breast implants.
加速部分乳腺照射现已成为保乳治疗的一个公认组成部分。然而，关于使用多腔导管系统治疗且已有乳房植入物的患者长期预后的数据有限。
我们报告了一名患者的治疗情况及预后，该患者就诊时已有双侧硅胶胸大肌下植入物。右乳超声引导下粗针活检显示为浸润性黏液癌。右乳肿块切除术显示有一个8毫米的浸润性导管癌区域，具有黏液特征，核分级为1级。放置了一个4 - 5厘米的Contura（巴德活检系统，亚利桑那州坦佩）装置，她在5天内每天接受两次治疗，使用高剂量率铱 - 192源，剂量为34 Gy。
用于评估的计划靶体积为73.9立方厘米。接受规定剂量90%、95%和100%的计划靶体积评估百分比分别为99.9%、99.3%和97.8%。植入物总体积为234.5立方厘米，平均剂量为15.4 Gy，最大剂量为72.8 Gy。接受规定剂量50%、75%、100%和200%的植入物体积百分比分别为31.1%、16.5%、8.6%、2.0%和0%。最大皮肤剂量为规定剂量的97%。随访近5年，她仍无癌症，晚期毒性极小，美容效果良好至极佳。
对于已有乳房植入物的患者，使用多腔球囊施源器进行加速部分乳腺照射可以安全地进行，长期美容效果极佳。需要进一步研究来确定乳房植入物的绝对剂量耐受性。
