Pohanková Denisa, Sirák Igor, Jandík Pavel, Kašaova Linda, Grepl Jakub, Motyčka Petr, Asqar Ahmed, Paluska Petr, Ninger Vladimír, Bydžovská Ivana, Kopecky Viliam, Petera Jiří
Department of Oncology and Radiotherapy, University Hospital and Medical Faculty, Hradec Králové, Czech Republic.
Department of Oncology and Radiotherapy, University Hospital and Medical Faculty, Hradec Králové, Czech Republic.
Brachytherapy. 2018 Nov-Dec;17(6):949-955. doi: 10.1016/j.brachy.2018.08.012. Epub 2018 Sep 15.
To assess the feasibility of high-dose-rate perioperative multicatheter interstitial brachytherapy to deliver accelerated partial breast irradiation (APBI) in selected patients with early breast cancer.
Perioperative multicatheter interstitial brachytherapy for APBI has been used at our department since 2012 for patients with low-risk breast cancer. Interstitial catheters were inserted perioperatively via hollow needles immediately following tumorectomy with sentinel node biopsy. APBI started on Day 6 after surgery. The prescribed dose was 34 Gy (10 fractions of 3.4 Gy bid). Hormonal therapy was prescribed in all cases.
Between June 2012 and December 2017, 125 patients were scheduled for APBI. Of these, APBI was not performed in 12 patients (9.6%) due to adverse prognostic factors identified on the definitive biopsy. We observed wound dehiscence in 2/113 cases (1.8%), inflammatory complications requiring antibiotics in 7/113 cases (6.2%), transient Grade I radiodermatitis in 6/113 patients (4.4%), and seroma which resolved spontaneously in 3/113 patients (2.7%). With median followup of 39 months (range 3.3-75.3) no relapses were observed. No late complications in Radiation Therapy Oncology Group Grade 3 or higher were documented. Cosmetic outcome in patients with followup > 2 years was excellent or good in 92%.
Our preliminary results show that the perioperative multicatheter interstitial high-dose-rate brachytherapy for APBI in selected patients with early breast cancer is feasible. This treatment schedule reduces treatment duration, spares the patients of repeated anesthesia, and enables precise application of the afterloading tubes under direct visual control.
评估高剂量率围手术期多导管组织间近距离放射治疗在部分早期乳腺癌患者中进行加速部分乳腺照射（APBI）的可行性。
自2012年起，我们科室对低风险乳腺癌患者采用围手术期多导管组织间近距离放射治疗进行APBI。在肿瘤切除及前哨淋巴结活检后，通过空心针在围手术期插入组织间导管。APBI于术后第6天开始。规定剂量为34 Gy（10次分割，每次3.4 Gy，每日两次）。所有病例均给予激素治疗。
2012年6月至2017年12月期间，125例患者计划接受APBI。其中，12例患者（9.6%）因在确诊活检中发现不良预后因素而未进行APBI。我们观察到2/113例（1.8%）出现伤口裂开，7/113例（6.2%）出现需要使用抗生素的炎症并发症，6/113例患者（4.4%）出现短暂的I级放射性皮炎，3/113例患者（2.7%）出现自行消退的血清肿。中位随访39个月（范围3.3 - 75.3个月），未观察到复发。未记录到放射肿瘤学组3级或更高等级的晚期并发症。随访>2年的患者中，92%的美容效果为优或良。
我们的初步结果表明，在部分早期乳腺癌患者中，围手术期多导管组织间高剂量率近距离放射治疗用于APBI是可行的。这种治疗方案缩短了治疗时间，避免了患者反复接受麻醉，并能在直视控制下精确放置后装管。
