Shah Chirag, Wobb Jessica, Manyam Bindu, Khan Atif, Vicini Frank
Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio.
Department of Radiation Oncology, Ohio State University, Columbus, Ohio.
J Contemp Brachytherapy. 2016 Feb;8(1):90-4. doi: 10.5114/jcb.2016.58083. Epub 2016 Feb 29.
Accelerated partial breast irradiation (APBI) represents an evolving technique that is a standard of care option in appropriately selected woman following breast conserving surgery. While multiple techniques now exist to deliver APBI, interstitial brachytherapy represents the technique used in several randomized trials (National Institute of Oncology, GEC-ESTRO). More recently, many centers have adopted applicator-based brachytherapy to deliver APBI due to the technical complexities of interstitial brachytherapy. The purpose of this article is to review methods to evaluate and select patients for APBI, as well as to define potential workflow mechanisms that allow for the safe and effective delivery of APBI. Multiple consensus statements have been developed to guide clinicians on determining appropriate candidates for APBI. However, recent studies have demonstrated that these guidelines fail to stratify patients according to the risk of local recurrence, and updated guidelines are expected in the years to come. Critical elements of workflow to ensure safe and effective delivery of APBI include a multidisciplinary approach and evaluation, optimization of target coverage and adherence to normal tissue guideline constraints, and proper quality assurance methods.
加速部分乳腺照射（APBI）是一种不断发展的技术，对于保乳手术后经过适当筛选的女性而言，它是一种标准的治疗选择。虽然目前有多种技术可用于实施APBI，但组织间近距离放射治疗是多项随机试验（国家肿瘤研究所、GEC-ESTRO）中所采用的技术。最近，由于组织间近距离放射治疗的技术复杂性，许多中心已采用基于施源器的近距离放射治疗来实施APBI。本文的目的是回顾评估和选择APBI患者的方法，以及确定能够实现APBI安全有效实施的潜在工作流程机制。已经制定了多项共识声明，以指导临床医生确定APBI的合适人选。然而，最近的研究表明，这些指南未能根据局部复发风险对患者进行分层，预计未来几年将会更新指南。确保APBI安全有效实施的工作流程的关键要素包括多学科方法和评估、靶区覆盖优化以及对正常组织指南限制的遵守，还有适当的质量保证方法。
