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乳腺癌保乳手术与术中放疗。我们能否预测纤维化？

Breast-conserving surgery in breast cancer and intraoperative radiotherapy. Can we predict the fibrosis?

作者信息

Vallejo Bernad Cristina, Casamayor Franco Maria Del Carmen, Pérez-Tierra Ruiz Jesús Víctor, Martínez Lahoz Yaiza, Carrasquer Puyal Aurora, Pallarés Segura José Luis, Sánchez Marín Juan Pelegrín, Barra Pardos María Victoria

机构信息

Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario Miguel Servet, Zaragoza, España.

Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario Miguel Servet, Zaragoza, España.

出版信息

Cir Esp (Engl Ed). 2019 Nov;97(9):517-522. doi: 10.1016/j.ciresp.2019.05.012. Epub 2019 Jul 15.

DOI:10.1016/j.ciresp.2019.05.012
PMID:31320114
Abstract

INTRODUCTION

Radiotherapy techniques associated with breast-conserving surgery have evolved in early breast cancer thanks to a better knowledge of tumor radiobiology, highlighting intraoperative radiotherapy (IORT). However, complications have been documented with this procedure, mainly fibrosis. Transforming growth factor beta (TGF-β) is a cytokine with an active role in radiation-induced fibrosis, which could be used as an early biomarker for the development of fibrosis.

METHODS

Multicentric prospective analysis of 60 patients with breast cancer who underwent breast-conserving surgery, 30 of whom had received additional IORT. TGF-β values were evaluated in serum pre-surgery and in serum collected 24h after surgery. In addition, we evaluated surgical wound fluids collected 6h and 24h following surgery.

RESULTS

Serum and surgical wound fluids TGF-β values collected over 24h following surgery were significantly higher in patients who received additional IORT (P<.0001). Notably, 8 of these patients showed values above 1,000pg/ml. There were no differences between the samples (serum or surgical wound fluids) (P=.5881).

CONCLUSIONS

Although further investigation is needed, higher TGF-β values in IORT during breast-conserving surgery can be used as an early biomarker for the development of fibrosis.

摘要

引言

由于对肿瘤放射生物学有了更深入的了解，早期乳腺癌中与保乳手术相关的放疗技术不断发展，术中放疗（IORT）备受关注。然而，该手术已被证实存在并发症，主要是纤维化。转化生长因子β（TGF-β）是一种在辐射诱导的纤维化过程中起积极作用的细胞因子，可作为纤维化发展的早期生物标志物。

方法

对60例行保乳手术的乳腺癌患者进行多中心前瞻性分析，其中30例接受了额外的术中放疗。在术前血清以及术后24小时采集的血清中评估TGF-β值。此外，我们还评估了术后6小时和24小时收集的手术伤口液体。

结果

接受额外术中放疗的患者术后24小时内采集的血清和手术伤口液体中的TGF-β值显著更高（P<.0001）。值得注意的是，这些患者中有8例的值高于1000pg/ml。样本（血清或手术伤口液体）之间无差异（P=.5881）。

结论

尽管还需要进一步研究，但保乳手术中术中放疗时较高的TGF-β值可作为纤维化发展的早期生物标志物。

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