Smanykó Viktor, Mészáros Norbert, Újhelyi Mihály, Fröhlich Georgina, Stelczer Gábor, Major Tibor, Mátrai Zoltán, Polgár Csaba
Centre of Radiotherapy, National Institute of Oncology, Budapest, Hungary.
Centre of Radiotherapy, National Institute of Oncology, Budapest, Hungary; Department of Oncology, Semmelweis University, Faculty of Medicine, Budapest, Hungary.
Brachytherapy. 2019 May-Jun;18(3):411-419. doi: 10.1016/j.brachy.2019.02.004. Epub 2019 Mar 16.
The purpose of this study was to report the clinical outcomes of a second breast-conserving therapy (2nd BCT) with perioperative interstitial brachytherapy (iBT) vs. those of salvage mastectomy (sMT) in the treatment of ipsilateral breast tumor recurrences (IBTRs).
Between 1999 and 2015, 195 patients with IBTR after a previous breast-conserving treatment were salvaged either with reexcision and perioperative high-dose-rate iBT (n = 39), or with sMT (n = 156). In the 2nd BCT group, a total dose of 22 Gy in five fractions of 4.4 Gy was delivered to the tumor bed with intraoperatively implanted catheters for 3 consecutive days.
The median followup time was 59 months (1-189) in the 2nd BCT, and 56 months (3-189) in the sMT group. The mean size of IBTR was 16 mm (2-70) vs. 24 mm (2-90), respectively (p = 0.0005), but there were no other significant differences in patient- or IBTR-related parameters between the two groups. During the followup period, 4 of 39 (10.2%) and 28 of 156 (17.9%) second local recurrences (2nd LR) occurred in the 2nd BCT and the sMT group, respectively. The 5-year actuarial rate of 2nd LR was 6% vs. 18% (p = 0.22), the 5-year probability of disease-free, cancer-specific and overall survival was 69% vs. 65% (p = 0.13), 85% vs. 78% (p = 0.32), and 81% vs. 66% (p = 0.15), respectively. In the 2nd BCT group, the rate of good to excellent cosmesis was 70%.
2nd BCT with perioperative high-dose-rate iBT is a safe and feasible option for the management of IBTR, resulting in similar 5-year oncological outcomes and better cosmetic results compared with sMT.
本研究旨在报告采用围手术期组织间近距离放疗（iBT）的二次保乳治疗（2nd BCT）与挽救性乳房切除术（sMT）治疗同侧乳腺肿瘤复发（IBTR）的临床结果。
1999年至2015年间，195例既往接受过保乳治疗后出现IBTR的患者，分别接受再次切除加围手术期高剂量率iBT（n = 39）或sMT（n = 156）进行挽救性治疗。在2nd BCT组中，通过术中植入的导管连续3天向瘤床给予总剂量22 Gy，分5次给予，每次4.4 Gy。
2nd BCT组的中位随访时间为59个月（1 - 189个月），sMT组为56个月（3 - 189个月）。IBTR的平均大小分别为16 mm（2 - 70 mm）和24 mm（2 - 90 mm）（p = 0.0005），但两组在患者或IBTR相关参数方面无其他显著差异。随访期间，2nd BCT组39例中有4例（10.2%）、sMT组156例中有28例（17.9%）出现二次局部复发（2nd LR）。2nd LR的5年精算率分别为6%和18%（p = 0.22），5年无病生存率、癌症特异性生存率和总生存率分别为69%和65%（p = 0.13）、85%和78%（p = 0.32）、81%和66%（p = 0.15）。在2nd BCT组中，美容效果良好至优秀的比例为70%。
围手术期高剂量率iBT的2nd BCT是治疗IBTR的一种安全可行的选择，与sMT相比，5年肿瘤学结果相似，美容效果更好。
