Kamrava Mitchell, Kuske Robert R, Anderson Bethany, Chen Peter, Hayes John, Quiet Coral, Wang Pin-Chieh, Veruttipong Darlene, Snyder Margaret, Jeffrey Demanes D
Department of Radiation Oncology, University of California Los Angeles, Los Angeles, CA, USA.
Arizona Breast Cancer Specialists, Scottsdale, USA.
Ann Surg Oncol. 2015 Dec;22 Suppl 3:S404-11. doi: 10.1245/s10434-015-4563-7. Epub 2015 Apr 28.
To report outcomes for breast-conserving therapy using adjuvant accelerated partial breast irradiation with interstitial multicatheter brachytherapy by a cooperative group of institutions.
From 1992 to 2013, a total of 1356 patients were treated with breast-conserving surgery and adjuvant accelerated partial breast irradiation using interstitial multicatheter brachytherapy. A total of 1131 patients had >1 year of data available to assess oncologic and cosmesis outcomes. Median age was 59 years old (range 22-90 years). Histologies treated included 1005 (73 %) invasive ductal carcinoma and 240 (18 %) ductal carcinoma-in situ. T stages were 18 % Tis, 75 % T1, and 8 % ≥T2. Nodal status was 73 % N0 and 6 % N1a. Estrogen receptor, progesterone receptor, and human epidermal growth factor receptor 2 was positive in 83, 70, and 6 %, respectively. Cox multivariate analysis for local control was performed using histology, age, estrogen receptor status, tumor size, grade, margin, and nodal status.
The mean (SD) follow-up was 6.9 years (4.3). The 10-year actuarial risk (95 % confidence interval) of an ipsilateral breast tumor recurrence was 7.6 % (5.6-10.1). Other 10-year actuarial risks (95 % confidence interval) were regional failure 2.3 % (1.4-3.7), distant metastasis 3.8 % (2.5-5.7), cause-specific survival 96.3 % (94.2-97.6), overall survival 86.5 (83.0-89.3), and new contralateral cancers 4.6 % (3.0-6.9). On multivariate analysis, high grade (hazard ratio 2.81) and positive margin status (hazard ratio 18.42) were the only two significant variables associated with an increased risk of local recurrence. Physician-reported cosmesis was excellent/good in 84 % (98 of 116) of patients with >5 years of follow-up.
This is the largest report of outcomes with interstitial breast brachytherapy. This treatment resulted in excellent long-term local control and cosmesis outcomes.
报告一组合作机构采用组织间多导管近距离放射治疗辅助加速局部乳腺照射进行保乳治疗的结果。
1992年至2013年，共有1356例患者接受了保乳手术及采用组织间多导管近距离放射治疗的辅助加速局部乳腺照射。共有1131例患者有超过1年的数据可用于评估肿瘤学和美容效果。中位年龄为59岁（范围22 - 90岁）。治疗的组织学类型包括1005例（73%）浸润性导管癌和240例（18%）导管原位癌。T分期为18%Tis、75%T1和8%≥T2。淋巴结状态为73%N0和6%N1a。雌激素受体、孕激素受体和人表皮生长因子受体2阳性率分别为83%、70%和6%。使用组织学、年龄、雌激素受体状态、肿瘤大小、分级、切缘和淋巴结状态对局部控制进行Cox多变量分析。
平均（标准差）随访时间为6.9年（4.3年）。同侧乳腺肿瘤复发的10年精算风险（95%置信区间）为7.6%（5.6 - 10.1%）。其他10年精算风险（95%置信区间）为区域失败2.3%（1.4 - 3.7%）、远处转移3.8%（2.5 - 5.7%）、特定病因生存率96.3%（94.2 - 97.6%）、总生存率86.5%（83.0 - 89.3%）和对侧新发癌4.6%（3.0 - 6.9%）。多变量分析显示，高级别（风险比2.81）和切缘阳性状态（风险比18.42）是与局部复发风险增加相关的仅有的两个显著变量。在随访超过5年的患者中，医生报告的美容效果为优/良的占84%（116例中的98例）。
这是关于组织间乳腺近距离放射治疗结果的最大规模报告。该治疗产生了出色的长期局部控制和美容效果。
