Koh Yaling Vicky, Tan Poh Wee, Buhari Shaik Ahmad, Iau Philip, Chan Ching Wan, Shen Liang, Tan Sing Huang, Tang Johann I-Hsiung
Department of Radiation Oncology, National University Cancer Institute Singapore.
Department of Surgery, National University Hospital.
Onco Targets Ther. 2016 Sep 8;9:5561-6. doi: 10.2147/OTT.S106758. eCollection 2016.
Accelerated partial breast irradiation (APBI) using the multicatheter method has excellent cosmesis and low rates of long-term toxicity. However, there are few studies looking at the feasibility of this procedure and the outcomes in an Asian population. This study aims to look at outcomes at our hospital.
We identified 121 patients treated with APBI at our center between 2008 and 2014. The median follow-up for our patient group was 30 months (range 3.7-66.5). The prescribed dose per fraction was 3.4 Gy in 10 fractions. In this study population, 71% of the patients were Chinese while 15% (n=19) were of other Asian ethnicity.
In this study, the median breast volume was 850 cc (range 216-2,108) with 59.5% (n=72) patients with a breast volume of <1,000 cc. The average planning target volume was 134 cc (range 28-324). The number of catheters used ranged from 8 to 25 with an average of 18 catheters used per patient. We achieved an average dose homogeneity index of 0.76 in our patients. The average D90(%) was 105% and the average D90(Gy) was 3.6 Gy per fraction. The median volume receiving 100% of the prescribed dose (V100) was 161.7 cc (range 33.9-330.1), 150% of the prescribed dose (V150) and 200% of the prescribed dose (V200) was 39.4 cc (range 14.6-69.6) and 14.72 cc (range 6.48-22.25), respectively. Our dosimetric outcomes were excellent even in patients with breast volume under 1,000 cc. There were no cases of grade 3 skin toxicity or acute pneumonitis. Two patients had a postoperative infection and two patients had fat necrosis postprocedure.
Multicatheter high dose rate APBI is a safe and feasible procedure that can be carried out with minimal toxicity in Asian patients with breast volumes under 1,000 cc.
采用多导管法的加速部分乳腺照射（APBI）具有出色的美容效果和较低的长期毒性发生率。然而，针对该手术在亚洲人群中的可行性及结果的研究较少。本研究旨在观察我院的治疗结果。
我们确定了2008年至2014年间在我院接受APBI治疗的121例患者。我们患者组的中位随访时间为30个月（范围3.7 - 66.5个月）。每分次的处方剂量为3.4 Gy，共10次。在本研究人群中，71%的患者为中国人，15%（n = 19）为其他亚洲种族。
在本研究中，中位乳房体积为850 cc（范围216 - 2108），59.5%（n = 72）的患者乳房体积<1000 cc。平均计划靶体积为134 cc（范围28 - 324）。使用的导管数量范围为8至25根，平均每位患者使用18根导管。我们患者的平均剂量均匀性指数为0.76。平均D90（%）为105%，平均D90（Gy）为每次分次3.6 Gy。接受100%处方剂量（V100）的中位体积为161.7 cc（范围33.9 - 330.1），接受150%处方剂量（V150）和200%处方剂量（V200）的中位体积分别为39.4 cc（范围14.6 - 69.6）和14.72 cc（范围6.48 - 22.25）。即使在乳房体积小于1000 cc的患者中，我们的剂量学结果也很出色。没有3级皮肤毒性或急性肺炎的病例。两名患者术后发生感染，两名患者术后出现脂肪坏死。
多导管高剂量率APBI是一种安全可行的手术，对于乳房体积小于1000 cc的亚洲患者，可在毒性最小的情况下进行。
