Chowdhry Varun K, Bushey Julie A, Kwait Rebecca M, Goldberg Saveli, Ritchie Jeannine, Ji Yong-Li, McKee Roderick, Palladino Diane, Proulx Gary M
1Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA USA.
2Department of Radiation Oncology, Exeter Hospital, Exeter, NH, USA.
J Radiat Oncol. 2018;7(2):167-173. doi: 10.1007/s13566-017-0338-z. Epub 2017 Dec 19.
Adjuvant whole breast radiation therapy has developed into the standard of care for patients following a lumpectomy for early-stage breast cancer. However, there is recent interest in intraoperative radiation therapy (IORT) to minimize toxicity while still improving local control beyond surgical resection and anti-estrogen therapy alone.
All patients were evaluated pre-operatively in a multidisciplinary clinic setting at a community hospital for suitability for breast conservation therapy. A total of 109 patients were reviewed receiving 110 IORT treatments. Patients were followed with clinical breast examinations and mammography as clinically indicated.
At a median follow-up of 29.9 months, 2/110 (1.8%) patients experienced a local failure. One patient (0.9%) experienced a regional failure. Local control, disease-free survival and overall survival at 3 years were 98.9% (95%CI 92.2-99.8), 97.2% (95%CI 88.9-99.3), and 96.0% (95%CI 84.9-99.0), respectively. Five-year local control, disease-free survival, and overall survival rates were 96.3% (95%CI 84.7-99.2), 94.6% (95%CI 83.2-98.3), and 92.5% (95%CI 80.4-97.3), respectively. Patient self-reported cosmetic outcome was available for 51 patients, with all patients reporting being either very pleased, pleased, or satisfied with their cosmetic outcome, and no patients reported being dissatisfied or worse.
The results of our series suggest the feasibility of utilizing IORT in a community-based cancer center with a high degree of local control, and patient satisfaction with regard to cosmesis. While the results of this series suggest that IORT may be a promising modality, longer follow-up is warranted to better understand exactly which clinicopathological features can predict long-term locoregional disease control.
辅助性全乳放疗已发展成为早期乳腺癌保乳术后患者的标准治疗方案。然而，近期人们对术中放疗（IORT）产生了兴趣，旨在在尽量减少毒性的同时，在单纯手术切除和抗雌激素治疗的基础上进一步提高局部控制率。
所有患者均在社区医院的多学科门诊进行术前评估，以确定是否适合保乳治疗。共对109例接受110次IORT治疗的患者进行了回顾性分析。根据临床指征，对患者进行临床乳腺检查和乳房X线摄影随访。
中位随访29.9个月时，110例患者中有2例（1.8%）出现局部复发。1例患者（0.9%）出现区域复发。3年时的局部控制率、无病生存率和总生存率分别为98.9%（95%CI 92.2 - 99.8）、97.2%（95%CI 88.9 - 99.3）和96.0%（95%CI 84.9 - 99.0）。5年时的局部控制率、无病生存率和总生存率分别为96.3%（95%CI 84.7 - 99.2）、94.6%（95%CI 83.2 - 98.3）和92.5%（95%CI 80.4 - 97.3）。51例患者有患者自我报告的美容效果，所有患者均表示对美容效果非常满意、满意或基本满意，无患者报告不满意或效果较差。
我们系列研究的结果表明，在社区癌症中心使用IORT具有可行性，局部控制率高，患者对美容效果满意。虽然本系列研究结果表明IORT可能是一种有前景的治疗方式，但仍需要更长时间的随访，以更好地了解哪些临床病理特征能够预测长期的局部区域疾病控制情况。
