Raju-Salicki Silpa, Stowe Hayley B, D'Souza Alden, Huang Yi, Mahmood Mustafaa, Kennedy William R, Brenneman Randall J, Margenthaler Julie, Glover-Collins Katherine, Cyr Amy, Bergom Carmen, Yang Joanna, Thomas Maria A, Zoberi Jacqueline, Zoberi Imran
Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri.
Charleston Radiation Therapy Consultants, Charleston, West Virginia.
Adv Radiat Oncol. 2025 May 23;10(7):101792. doi: 10.1016/j.adro.2025.101792. eCollection 2025 Jul.
To report long-term institutional outcomes for ductal carcinoma in situ treated with accelerated partial breast irradiation (APBI) using multiple modalities as a part of breast-conserving therapy.
From January 2001 to April 2019, 240 patients with stage 0 breast cancer were treated with breast-conserving surgery (BCS) and adjuvant APBI at our institution. Based on the 2024 American Society for Radiology and Oncology (ASTRO) APBI guidelines, 170 patients were "recommended," 68 were "conditionally recommended," and 2 were "not recommended" for APBI. A total of 102 patients were treated with linear accelerator-based external beam radiation therapy, 38 with magnetic resonance image-guided external beam radiation therapy (MRgEBRT), 49 with multicatheter interstitial implant (ISI) brachytherapy, and 51 with intracavitary applicator brachytherapy (strut-adjusted volume implant). Patients treated with external beam radiation therapy received 3850 cGy in 10 fractions twice a day. Patients treated with ISI or strut-adjusted volume implant received 3400 cGy in 10 fractions twice a day. Recurrence and survival were calculated using the Kaplan-Meier method. Cosmesis was scored by the Harvard criteria.
At a median follow-up of 11.5 years (range, 1.2-17.8 years), the overall and cause-specific survival rates were 94.8% and 100%, respectively. The 10-year ipsilateral breast tumor recurrence rate was 3.8%. There were 9 observed ipsilateral breast tumor recurrences with 1 concurrent ipsilateral regional lymph node recurrence. No other breast failures, regional recurrences, or distant metastases were noted. Breast cancer-specific survival (BCSS) was 99.6% at the time of analysis. There was no statistically significant difference in overall survival or recurrence rates between the different treatment modalities. Cosmesis was excellent or good in 90% of cases without a statistically significant difference between the treatment method, 2024 American Society for Radiology and Oncology APBI criteria, or the 2022 American Brachytherapy Society (ABS) APBI acceptability categories.
APBI as a component of breast-conserving therapy for pure ductal carcinoma in situ is associated with excellent survival rates, local control, and cosmetic outcomes regardless of radiation therapy modality.
报告作为保乳治疗一部分，采用多种方式进行加速局部乳腺照射（APBI）治疗导管原位癌的长期机构治疗结果。
2001年1月至2019年4月，240例0期乳腺癌患者在本机构接受了保乳手术（BCS）及辅助APBI治疗。根据2024年美国放射学会和肿瘤学会（ASTRO）的APBI指南，170例患者被“推荐”进行APBI，68例被“有条件推荐”，2例被“不推荐”进行APBI。共有102例患者接受了基于直线加速器的外照射放疗，38例接受了磁共振成像引导的外照射放疗（MRgEBRT），49例接受了多导管组织间插植（ISI）近距离放疗，51例接受了腔内施源器近距离放疗（支柱调整体积插植）。接受外照射放疗的患者每天两次，分10次给予3850 cGy。接受ISI或支柱调整体积插植的患者每天两次，分10次给予3400 cGy。采用Kaplan-Meier法计算复发率和生存率。美容效果根据哈佛标准进行评分。
中位随访11.5年（范围1.2 - 17.8年），总生存率和病因特异性生存率分别为94.8%和100%。10年同侧乳腺肿瘤复发率为3.8%。观察到9例同侧乳腺肿瘤复发，其中1例同时伴有同侧区域淋巴结复发。未发现其他乳腺失败、区域复发或远处转移。分析时乳腺癌特异性生存率（BCSS）为99.6%。不同治疗方式之间的总生存率或复发率无统计学显著差异。90%的病例美容效果为优或良，治疗方法、2024年美国放射学会和肿瘤学会APBI标准或2022年美国近距离放射治疗学会（ABS）APBI可接受类别之间无统计学显著差异。
无论放疗方式如何，APBI作为纯导管原位癌保乳治疗的一部分，均具有出色的生存率、局部控制率和美容效果。
