Akhtari Mani, Abboud Mirna, Szeja Sean, Pino Ramiro, Lewis Gary D, Bass Barbara L, Miltenburg Darlene M, Butler E Brian, Teh Bin S
Department of Radiation Oncology, University of Texas Medical Branch, Galveston, TX; Department of Radiation Oncology, Houston Methodist Hospital, Cancer Center and Research Institute, Houston, TX.
Department of Radiation Oncology, Houston Methodist Hospital, Cancer Center and Research Institute, Houston, TX.
J Contemp Brachytherapy. 2016 Dec;8(6):497-504. doi: 10.5114/jcb.2016.64830. Epub 2016 Dec 29.
Accelerated partial breast irradiation (APBI) using a single-lumen device is associated with better cosmetic outcomes if the spacing between the applicator and skin is > 7 mm. However, there are no reports addressing the late toxicity and clinical outcomes in patients treated with single-entry multi-lumen/catheter applicators who had close skin spacing (7 mm or less). We undertook this study to report clinical outcome, acute and late toxicity as well as cosmesis of early stage breast cancer patients with close skin spacing treated with APBI using multi-lumen or multi-catheter devices.
This is a retrospective study of all breast cancer patients who had undergone APBI using single-entry multi-lumen/catheter devices in a single institution between 2008 to 2012. The study was limited to those with ≤ 7 mm spacing between the device and skin.
We identified 37 patients and 38 lesions with skin spacing of ≤ 7 mm. Seven lesions (18%) had spacing of ≤ 3 mm. Median follow-up was 47.5 months. There was one case of ipsilateral breast recurrence and one ipsilateral axillary recurrence. Based on RTOG criteria, 22 treated lesions experienced grade 1 and 9 lesions experienced grade 2 toxicity. Twenty-one lesions experienced late grade 1 toxicity. One patient had to undergo mastectomy due to mastitis. Twenty-four treated breasts showed excellent and 11 had good cosmetic outcome. Overall cosmesis trended towards a significant correlation with skin spacing. However, all patients with ≤ 3 mm skin spacing experienced acute and late toxicities.
Accelerated partial breast irradiation can be safely performed in patients with skin spacing of ≤ 7 mm using single-entry multi-lumen/catheter applicators with excellent cosmetic outcomes and an acceptable toxicity profile. However, skin spacing of ≤ 3 mm is associated with acute and late toxicity and should be avoided if possible.
如果施源器与皮肤之间的间距大于7毫米，使用单腔装置进行加速部分乳腺照射（APBI）可带来更好的美容效果。然而，尚无关于使用单入口多腔/导管施源器且皮肤间距较近（7毫米或更小）的患者的晚期毒性和临床结局的报告。我们开展这项研究以报告使用多腔或多导管装置进行APBI治疗的皮肤间距较近的早期乳腺癌患者的临床结局、急性和晚期毒性以及美容效果。
这是一项对2008年至2012年期间在单一机构使用单入口多腔/导管装置接受APBI治疗的所有乳腺癌患者的回顾性研究。该研究仅限于装置与皮肤间距≤7毫米的患者。
我们确定了37例患者和38个病灶，其皮肤间距≤7毫米。7个病灶（18%）的间距≤3毫米。中位随访时间为47.5个月。有1例同侧乳腺复发和1例同侧腋窝复发。根据RTOG标准，22个接受治疗的病灶出现1级毒性，9个病灶出现2级毒性。21个病灶出现晚期1级毒性。1例患者因乳腺炎不得不接受乳房切除术。24个接受治疗的乳房显示美容效果极佳，11个乳房美容效果良好。总体美容效果与皮肤间距呈显著相关趋势。然而，所有皮肤间距≤3毫米的患者均出现急性和晚期毒性。
使用单入口多腔/导管施源器对皮肤间距≤7毫米的患者进行加速部分乳腺照射可安全进行，美容效果极佳且毒性可接受。然而，皮肤间距≤3毫米与急性和晚期毒性相关，应尽可能避免。
