Yu Wei, Lin Zhi, Ju Zhong-Jian, Li Xi-Ru, Zhang Yan-Jun, Kong Qing-Long, Gong Han-Shun, Wang Jian-Dong, Ma Lin
Department of Radiotherapy, Chinese PLA General Hospital Beijing 100853, China.
Department of Medical Oncology, Chinese PLA General Hospital Beijing 100853, China.
Am J Cancer Res. 2015 Jun 15;5(7):2249-57. eCollection 2015.
To evaluate the safety, cosmesis, and clinical outcome of intraoperative electron radiation therapy (IOERT) delivered prior to lumpectomy for early-stage breast cancer.
From December 2008 to March 2012, 75 breast cancer patients (ages 34-66 years) were treated with IOERT during breast conservative surgery. IOERT was delivered using a mobile linear accelerator. Suitable energy and applicator size were chosen to ensure coverage of the tumor with anterior and posterior margins of 1 cm and lateral margins of 2 cm. Patients with sentinel node metastases or younger than 40 years received 8 Gy as boost followed by post-operative external beam radiation therapy of 50 Gy/25F; the others had 15 Gy, prescribed to the 90% isodose depth. Adjuvant treatment consisted of chemotherapy (55 patients), hormonal therapy (59 patients), or combined chemotherapy and hormonal therapy (41 patients). The safety, cosmesis, and short-term outcome were evaluated.
Median follow-up was 54 months (range: 30-66 months). Two (2.7%) patients developed post-surgical hematoma. Six (8.0%) patients developed mild breast fibrosis. Eight (10.7%) patients suffered from local pain. One (1.2%) patient experienced a post-operative infection. Sixteen (21.3%) patients developed Grade 1 pulmonary fibrosis. Forty-three (57.3%) patients had an excellent cosmetic result and 23 (30.7%) had a good cosmetic result. Three patients had an ipsilateral breast recurrence, with an actual 3-year local recurrence rate of 4.0%. One patient had an ipsilateral axillary recurrence, resulting in a 3-year regional recurrence rate of 1.3%. No distant metastases or deaths were observed. The 3-year disease free survival was 94.6%.
Intraoperative electron radiation therapy delivered prior to lumpectomy is safe and feasible for selected patients with early-stage breast cancer. Early side effects, cosmesis and short-term efficacy are acceptable, but a longer follow-up is needed for evaluation of late side effects and long-term outcome.
评估早期乳腺癌保乳手术前行术中电子线放射治疗（IOERT）的安全性、美容效果及临床结局。
2008年12月至2012年3月，75例年龄在34 - 66岁的乳腺癌患者在保乳手术中接受了IOERT治疗。使用移动直线加速器进行IOERT治疗。选择合适的能量和施源器尺寸，以确保肿瘤前后缘各1 cm、侧缘2 cm的范围得到覆盖。前哨淋巴结转移或年龄小于40岁的患者接受8 Gy的追加剂量放疗，随后进行50 Gy/25F的术后外照射放疗；其他患者接受15 Gy，处方剂量至90%等剂量深度。辅助治疗包括化疗（55例患者）、激素治疗（59例患者）或化疗联合激素治疗（41例患者）。对安全性、美容效果及短期结局进行评估。
中位随访时间为54个月（范围：30 - 66个月）。2例（2.7%）患者发生术后血肿。6例（8.0%）患者出现轻度乳腺纤维化。8例（10.7%）患者出现局部疼痛。1例（1.2%）患者发生术后感染。16例（21.3%）患者出现1级肺纤维化。43例（57.3%）患者美容效果极佳，23例（30.7%）患者美容效果良好。3例患者同侧乳腺复发，实际3年局部复发率为4.0%。1例患者同侧腋窝复发，3年区域复发率为1.3%。未观察到远处转移或死亡。3年无病生存率为94.6%。
对于部分早期乳腺癌患者，保乳手术前行术中电子线放射治疗是安全可行的。早期副作用、美容效果及短期疗效均可接受，但需要更长时间的随访以评估晚期副作用及长期结局。
