Perera F, Chisela F, Engel J, Venkatesan V
Department of Radiation Oncology, London Regional Cancer Centre, Ontario, Canada.
Int J Radiat Oncol Biol Phys. 1995 Feb 15;31(4):959-65. doi: 10.1016/0360-3016(94)00576-1.
This article describes our technique of localization and implantation of the lumpectomy site of patients with T1 and T2 breast cancer. Our method was developed as part of our Phase I/II pilot study of high dose rate (HDR) brachytherapy alone after conservative surgery for early breast cancer.
In March 1992, we started a pilot study of HDR brachytherapy to the lumpectomy site as the sole radiotherapy after conservative surgery for clinical T1 or T2 invasive breast cancer. Initially, the protocol required intraoperative placement of the interstitial needles at the time of definitive surgery to the breast. The protocol was then generalized to allow the implantation of the lumpectomy site after definitive surgery to the breast, either at the time of subsequent axillary nodal dissection or postoperatively. To date, five patients have been implanted intraoperatively at the time of definitive breast surgery. Twelve patients were implanted after definitive breast surgery, with 7 patients being done at the time of axillary nodal dissection and 5 patients postoperatively. We devised a method of accurately localizing and implanting the lumpectomy site after definitive breast surgery. The method relies on the previous placement of surgical clips by the referring surgeon to mark the lumpectomy site. For each patient, a breast mold is made with radio-opaque angiocatheters taped onto the mold in the supero-inferior direction. A planning CT scan is then obtained through the lumpectomy site. The volume of the lumpectomy site, the number of implant planes necessary, and the orientation of the implants are then determined from the CT scan. The angiocatheters provide a reference grid on the CT films to locate the entry and exit points of the interstitial needles on the plastic mold. The entry and exit points for reference needles are then transferred onto the patient's skin enabling implantation of the lumpectomy site. Needle positions with respect to the lumpectomy site are then verified using simulator radiographs.
Eight double plane implants and four single plane implants have been done using this method. Five implants were done using direct visualization. It has not been necessary to reorient the implant in any of the patients. If not for the presence of surgical clips, the size of the lumpectomy site cannot be separated from the surrounding normal breast tissue.
This technique is an accurate way to localize the lumpectomy site for HDR brachytherapy.
本文介绍了我们对T1和T2期乳腺癌患者乳房肿瘤切除部位进行定位和植入的技术。我们的方法是作为早期乳腺癌保守手术后单纯高剂量率（HDR）近距离放射治疗I/II期试点研究的一部分而开发的。
1992年3月，我们开始了一项对乳房肿瘤切除部位进行HDR近距离放射治疗的试点研究，作为临床T1或T2期浸润性乳腺癌保守手术后的唯一放疗方法。最初，方案要求在对乳房进行根治性手术时术中放置组织间针。该方案随后推广到允许在对乳房进行根治性手术后，在后续腋窝淋巴结清扫时或术后对乳房肿瘤切除部位进行植入。迄今为止，有5例患者在乳房根治性手术时术中进行了植入。12例患者在乳房根治性手术后进行了植入，其中7例在腋窝淋巴结清扫时进行，5例在术后进行。我们设计了一种在乳房根治性手术后准确对乳房肿瘤切除部位进行定位和植入的方法。该方法依赖于转诊外科医生先前放置手术夹来标记乳房肿瘤切除部位。对于每位患者，制作一个乳房模具，将不透射线的血管导管沿上下方向粘贴在模具上。然后通过乳房肿瘤切除部位进行计划CT扫描。然后根据CT扫描确定乳房肿瘤切除部位的体积、所需植入平面的数量以及植入物的方向。血管导管在CT片上提供一个参考网格，以在塑料模具上定位组织间针的进针点和出针点。然后将参考针的进针点和出针点转移到患者皮肤上，从而能够对乳房肿瘤切除部位进行植入。然后使用模拟X光片验证针相对于乳房肿瘤切除部位的位置。
使用该方法已完成8例双平面植入和4例单平面植入。5例植入采用直接可视化方式。所有患者均无需重新调整植入方向。如果没有手术夹，乳房肿瘤切除部位的大小无法与周围正常乳腺组织区分开来。
该技术是一种准确对乳房肿瘤切除部位进行定位以进行HDR近距离放射治疗的方法。
