Schuster Jessica, Chipko Christopher, Kasper Michael, Sha Sandra, Ciuba Douglas, Petrikas James, Kuruvilla Anand, Sandrapaty Ravichandra, Quiet Coral, Anderson Cynthia, Benda Rashmi, Wazer David, Hepel Jaroslaw, Arthur Douglas
Department of Radiation Oncology, Virginia Commonwealth University, Richmond, VA.
Department of Radiation Oncology, Virginia Commonwealth University, Richmond, VA.
Brachytherapy. 2016 Nov-Dec;15(6):804-811. doi: 10.1016/j.brachy.2016.09.003. Epub 2016 Oct 6.
To report updated feasibility and reproducibility results for high-dose-rate noninvasive breast brachytherapy (NIBB) for tumor bed boost with whole breast radiation therapy (WBRT) in the setting of expanded patient and treatment facility number.
Fifteen independent community-based and academic centers reported 518 early-stage breast cancer patients from July 2007 to February 2015 on a privacy-encrypted online data registry. All patients' treatment included lumpectomy followed by combination of WBRT and NIBB. NIBB was completed with commercially available (AccuBoost, Billerica, MA) mammography-based system using high-dose-rate Ir emissions along orthogonal axes. Harvard scale was used to grade cosmesis.
Total patient cohort had median followup of 12 months (1-75 months) with subset of 268 having available cosmesis. Greater than 2- and 3-year followup was 29% and 14%, respectively. Entire cohort had 97.4% excellent/good (E/G) breast cosmesis and freedom from recurrence of 97.6% at the final followup. WBRT timing with respect to NIBB delivery demonstrated no statistically significant difference in E/G cosmesis. Achieved E/G cosmesis rate was also not statistically significant (χp-value = 0.86) between academic and community institutions with 97.8% vs. 96.6%.
NIBB represents an alternative method for delivery of breast tumor cavity boost that has shown feasibility in a diverse group of both academic and community-based practices with reproducible early cosmesis and tumor control results. Recommendations are updated noting ideal timing of boost delivery likely to be before or early during WBRT given equal cosmesis and less documented treatment discomfort.
报告在扩大患者和治疗机构数量的情况下，高剂量率无创性乳腺近距离放射治疗（NIBB）联合全乳放疗（WBRT）用于瘤床加量的最新可行性和可重复性结果。
15个独立的社区和学术中心于2007年7月至2015年2月在一个隐私加密的在线数据登记系统中报告了518例早期乳腺癌患者。所有患者均接受了保乳手术，随后进行WBRT和NIBB联合治疗。NIBB使用基于乳腺摄影的商用系统（AccuBoost，马萨诸塞州比勒里卡），沿正交轴发射高剂量率铱射线完成。采用哈佛量表对美容效果进行分级。
患者总队列的中位随访时间为12个月（1 - 75个月），其中268例有美容效果数据。2年和3年以上随访率分别为29%和14%。在最后一次随访时，整个队列的乳房美容效果优良率为97.4%，无复发生存率为97.6%。WBRT与NIBB治疗时间间隔在美容效果优良率方面无统计学显著差异。学术机构和社区机构之间的美容效果优良率也无统计学显著差异（χp值 = 0.86），分别为97.8%和96.6%。
NIBB是一种用于乳腺肿瘤腔加量的替代方法，在不同的学术和社区实践中均显示出可行性，具有可重复的早期美容效果和肿瘤控制结果。鉴于美容效果相同且治疗不适记录较少，建议更新为瘤床加量的理想时间可能在WBRT之前或早期。
