Department of radiotherapy, institut de cancérologie de Lorraine, 54519 Vandœuvre-lès-Nancy, France; Faculté de médecine de Nancy, université de Lorraine, 9, avenue de la Forêt de Haye, 54505 Vandœuvre-lès-Nancy, France.
Department of radiotherapy, institut de cancérologie de Lorraine, 54519 Vandœuvre-lès-Nancy, France.
Cancer Radiother. 2022 May;26(3):450-457. doi: 10.1016/j.canrad.2021.06.001. Epub 2021 Jun 16.
To focus on technical aspects of the implementation of interstitial high dose rate brachytherapy, with a step-by-step approach.
Patients were selected during multidisciplinary tumor boards, according to inclusion criteria adapted from GEC-ESTRO guidelines. A CT scan was performed a few days before implantation. On pre-implant CT, using surgical scar and clips, surgical and pathological reports, and preoperative images, we delineated the tumor bed to be included in the Clinical Target Volume (CTV), according to GEC ESTRO Recommendations. A 3D virtual implant simulation of the best catheter positions was performed in order to cover the target volume. Implantation was then carried out under local anaesthetic using 3D projections of the catheter inlets and outlets. Dosimetry was performed on post-implantation CT scan. A dose of 34Gy was delivered in 10 fractions. Acute and late side effects, and local control were evaluated 2 and 8 months after treatment.
Between July 2017 and January 2020, 20 patients were treated with accelerated partial breast irradiation. Dose constraints regarding target volume coverage, overdose, dose homogeneity, conformation index and organs at risk were met in 94.7%, 100%, 63.2%, 0% and 89.5% of the treatment plans, respectively. Grade 1-2 acute adverse events were observed in 21% of patients, with no grade 3-4 events.
The first dosimetric results and early clinical tolerance and efficacy achieved by the implementation of breast interstitial multicatheter brachytherapy in routine clinical practice are very encouraging, and confirm the interest of extending this practice.
专注于间质内高剂量率近距离放射治疗实施的技术方面，采用逐步的方法。
根据 GEC-ESTRO 指南改编的纳入标准，在多学科肿瘤委员会期间选择患者。在植入前几天进行 CT 扫描。在植入前 CT 上，我们使用手术疤痕和夹、手术和病理报告以及术前图像，根据 GEC ESTRO 建议描绘包含在临床靶区（CTV）中的肿瘤床。为了覆盖目标体积，进行了最佳导管位置的 3D 虚拟植入模拟。然后在局部麻醉下使用导管进出口的 3D 投影进行植入。在植入后 CT 扫描上进行剂量学评估。以 34Gy 的剂量分 10 次给予。在治疗后 2 个月和 8 个月评估急性和晚期副作用以及局部控制情况。
2017 年 7 月至 2020 年 1 月，20 例患者接受了加速部分乳房照射。94.7%、100%、63.2%、0%和 89.5%的治疗计划分别满足了目标体积覆盖、超量、剂量均匀性、形态指数和危及器官的剂量约束。21%的患者出现 1-2 级急性不良事件，无 3-4 级事件。
在常规临床实践中实施乳腺间质多导管近距离放射治疗的首次剂量学结果和早期临床耐受性以及疗效非常令人鼓舞，证实了推广这种治疗方法的兴趣。
