Hepel Jaroslaw T, Arthur Douglas, Shaitelman Simona, Polgár Csaba, Todor Dorin, Zoberi Imran, Kamrava Mitchell, Major Tibor, Yashar Catheryn, Wazer David E
Department of Radiation Oncology, Rhode Island Hospital, Brown University, Providence, RI; Department of Radiation Oncology, Tufts Medical Center, Tufts University, Boston, MA.
Department of Radiation Oncology, Virginia Commonwealth University School of Medicine, Richmond, VA.
Brachytherapy. 2017 Sep-Oct;16(5):919-928. doi: 10.1016/j.brachy.2017.05.012. Epub 2017 Jul 1.
To develop a consensus report for the quality practice of accelerated partial breast irradiation (APBI) using interstitial multicatheter brachytherapy (IMB).
The American Brachytherapy Society Board appointed an expert panel with clinical and research experience with breast brachytherapy to provide guidance for the current practice of IMB. This report is based on a comprehensive literature review with emphasis on randomized data and expertise of the panel.
Randomized trials have demonstrated equivalent efficacy of APBI using IMB compared with whole breast irradiation for select patients with early-stage breast cancer. Several techniques for placement of interstitial catheters are described, and importance of three-dimensional planning with appropriate optimization is reviewed. Optimal target definition is outlined. Commonly used dosing schemas include 50 Gy delivered in pulses of 0.6-0.8 Gy/h using pulsed-dose-rate technique and 34 Gy in 10 fractions, 32 Gy in eight fractions, or 30 Gy in seven fractions using high-dose-rate technique. Potential toxicities and strategies for toxicity avoidance are described in detail. Dosimetric constraints include limiting whole breast volume that receives ≥50% of prescription dose to <60%, skin dose to ≤100% of prescription dose (≤60-70% preferred), chest wall dose to ≤125% of prescription dose, Dose Homogeneity Index to >0.75 (>0.85 preferred), V < 45 cc, and V < 14 cc. Using an optimal implant technique coupled with optimal planning and appropriate dose constraints, a low rate of toxicity and a good-to-excellent cosmetic outcome of ≥90% is expected.
IMB is an effective technique to deliver APBI for appropriately selected women with early-stage breast cancer. This consensus report has been created to assist clinicians in the appropriate practice of APBI using IMB.
制定一份关于使用组织间多导管近距离放疗（IMB）进行加速部分乳腺照射（APBI）的质量实践共识报告。
美国近距离放射治疗学会理事会任命了一个具有乳腺近距离放疗临床和研究经验的专家小组，为当前IMB的实践提供指导。本报告基于全面的文献综述，重点关注随机数据和专家小组的专业知识。
随机试验表明，对于部分早期乳腺癌患者，使用IMB的APBI与全乳照射疗效相当。描述了几种组织间导管放置技术，并回顾了三维规划及适当优化的重要性。概述了最佳靶区定义。常用的剂量方案包括使用脉冲剂量率技术以0.6 - 0.8 Gy/h的脉冲方式给予50 Gy，以及使用高剂量率技术给予34 Gy分10次、32 Gy分8次或30 Gy分7次。详细描述了潜在毒性及避免毒性的策略。剂量学限制包括将接受≥50%处方剂量的全乳体积限制在<60%，皮肤剂量限制在≤100%处方剂量（≤60 - 70%更佳），胸壁剂量限制在≤125%处方剂量，剂量均匀性指数>0.75（>0.85更佳），V<45 cc以及V<14 cc。采用最佳植入技术并结合最佳规划和适当的剂量限制，预计毒性发生率较低，美容效果良好至优秀的比例≥90%。
IMB是为适当选择的早期乳腺癌女性提供APBI的有效技术。本共识报告旨在协助临床医生正确使用IMB进行APBI实践。
