Paryani Nitesh N, Vallow Laura, Magalhaes Wilza, Heckman Michael G, Kim Siyong, Smith Ashley, Diehl Nancy N, McLaughlin Sarah
Department of Radiation Oncology, Mayo Clinic, Jacksonville, FL.
Department of Surgery, Mayo Clinic, Jacksonville, FL.
J Contemp Brachytherapy. 2015 Feb;7(1):29-34. doi: 10.5114/jcb.2015.49443. Epub 2015 Mar 5.
To investigate the incidence of and potential risk factors for fat necrosis in high dose-rate (HDR) balloon-based breast brachytherapy (BBB).
Fifty-four patients were treated postoperatively with HDR-BBB between May 2007 and December 2010. Median age was 71 years (range: 50-88 years). Median tumor size was 1 cm (range: 0.1-2.7 cm). Forty-four had invasive histology; 43% were grade 1, 24% grade 2, and 15% grade 3. The median margin size was 0.7 cm (range: 0.1-1.5 cm).
With a median follow-up of 2.9 years (range: 0.5-5.2 years), local control was 98% with one in-breast failure, and overall survival was 89%. Fifty percent of patients experienced fat necrosis. Seven patients were symptomatic, with the remainder detected by mammography alone. Two patients required surgical resection with pathology confirming fat necrosis; 1 required i.v. steroids. At 1, 3, and 5 years following treatment, estimated cumulative incidences of fat necrosis were 7.5%, 52.7%, and 60.6%. Breast laterality, location, tumor size, histology, margin size, balloon volume, skin distance, skin dose, and number of dwell positions were not significantly associated with fat necrosis on univariate analysis.
In this retrospective review of HDR-BBB, we found a 50% incidence of both asymptomatic and symptomatic fat necrosis. Only three patients, however, required intervention. None of the risk factors considered were significantly associated with fat necrosis. Further studies evaluating factors associated with fat necrosis for patients undergoing HDR-BBB are necessary to appropriately assess the risks associated with treatment.
探讨高剂量率（HDR）基于球囊的乳腺近距离放射治疗（BBB）中脂肪坏死的发生率及潜在危险因素。
2007年5月至2010年12月期间，54例患者接受了术后HDR-BBB治疗。中位年龄为71岁（范围：50 - 88岁）。中位肿瘤大小为1 cm（范围：0.1 - 2.7 cm）。44例为浸润性组织学；43%为1级，24%为2级，15%为3级。中位切缘大小为0.7 cm（范围：0.1 - 1.5 cm）。
中位随访2.9年（范围：0.5 - 5.2年），局部控制率为98%，有1例乳腺内复发，总生存率为89%。50%的患者发生了脂肪坏死。7例患者有症状，其余仅通过乳腺X线摄影检测到。2例患者需要手术切除，病理证实为脂肪坏死；1例需要静脉注射类固醇。治疗后1年、3年和5年，脂肪坏死的估计累积发生率分别为7.5%、52.7%和60.6%。单因素分析显示，乳腺侧别、位置、肿瘤大小、组织学、切缘大小、球囊体积、皮肤距离、皮肤剂量和驻留位置数量与脂肪坏死均无显著相关性。
在这项对HDR-BBB的回顾性研究中，我们发现无症状和有症状脂肪坏死的发生率均为50%。然而，只有3例患者需要干预。所考虑的危险因素均与脂肪坏死无显著相关性。有必要进一步研究评估接受HDR-BBB治疗患者中与脂肪坏死相关的因素，以适当评估治疗相关风险。
