Leonardi Maria, Cecconi Agnese, Luraschi Rosa, Rondi Elena, Cattani Federica, Lazzari Roberta, Morra Anna, Soto Santos, Zanagnolo Vanna, Galimberti Viviana, Gentilini Oreste, Peccatori Fedro, Jereczek-Fossa Barbara, Orecchia Roberto
Advanced Radiotherapy Center, European Institute of Oncology, Milan, Italy.
Scientific Direction, European Institute of Oncology, Milan, Italy.
Breast Care (Basel). 2017 Dec;12(6):396-400. doi: 10.1159/000479862. Epub 2017 Dec 13.
The aim of this study was to confirm our preliminary results with in vivo dosimetry in non-pregnant breast cancer patients receiving electron beam intraoperative radiotherapy (ELIOT) and to report on the first treatment in a pregnant woman.
Following our previous experience, 5 non-pregnant patients receiving ELIOT to the tumor bed after breast-conserving surgery (BCS) were studied with thermoluminescent dosimeters positioned in the subdiaphragmatic region, within the uterus, and in the ovarian region. In December 2011, the first pregnant breast cancer patient underwent BCS and ELIOT (21 Gy at 90% isodose) during the 15th week of gestation.
The mean dose to the subdiaphragmatic external region in the 5 non-pregnant patients was 5.57 mGy, while pelvic measurements were below 1 mGy. The actual dosimetry of the pregnant patient showed a mean subdiaphragmatic dose of 4.34 mGy, a mean suprapubic dose of 1.64 mGy, and mean ovarian doses of 1.48 mGy (right-sided) and 1.44 mGy (left-sided). The expected dose to the fetus was estimated as 0.84 mGy (0.004% of the prescribed dose).
ELIOT as an anticipated boost to the breast could be considered in pregnant women in the early second trimester, postponing whole-breast irradiation after delivery.
本研究的目的是在接受电子束术中放疗（ELIOT）的非妊娠乳腺癌患者中，通过体内剂量测定来确认我们的初步结果，并报告首例对孕妇的治疗情况。
根据我们之前的经验，对5例在保乳手术（BCS）后接受肿瘤床ELIOT治疗的非妊娠患者进行研究，将热释光剂量计置于膈下区域、子宫内和卵巢区域。2011年12月，首例妊娠乳腺癌患者在妊娠第15周时接受了BCS和ELIOT治疗（90%等剂量线处21 Gy）。
5例非妊娠患者膈下外部区域的平均剂量为5.57 mGy，而盆腔测量值低于1 mGy。该孕妇的实际剂量测定显示，膈下平均剂量为4.34 mGy，耻骨上平均剂量为1.64 mGy，卵巢平均剂量右侧为1.48 mGy，左侧为1.44 mGy。胎儿的预期剂量估计为0.84 mGy（占处方剂量的0.004%）。
对于妊娠中期早期的孕妇，可考虑将ELIOT作为对乳房的预期增强放疗，产后再推迟全乳照射。
