Accelerated Partial Breast Irradiation Via the Mammosite® Catheter: Preliminary Reports of a Single-Institution Experience
Accelerated Partial Breast Irradiation Via the Mammosite® Catheter: Preliminary Reports of a Single-Institution Experience
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DOI：
10.1111/j.1524-4741.2009.00836.x
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发表时间：
2009-11-01
期刊：
影响因子：
2.1
通讯作者：
Corvo, Renzo
中科院分区：
文献类型：
--
作者：
Guenzi, Marina;Giannelli, Flavio;Corvo, Renzo
几项研究表明，肿瘤切除术后大多数乳房内复发发生在原始肿瘤部位或附近，而同侧乳房复发的情况则很少发生。这表明放射剂量可以专门传递到肿瘤床，从而可以使用更大的剂量，而不会增加毒性并缩短总治疗时间。我们研究了 MammoSite 照射系统的使用，以分析并发症、美观和患者舒适度。 2004 年至 2007 年间，使用 MammoSite 装置对 30 名患者进行了腔内近距离放射治疗。参考等剂量被规定用于边缘为 1 cm 的肿瘤切除腔。植入后通过 CT、X 射线和超声检查施源器的几何参数和解剖位置。对患者的生活质量、美容、早期和晚期并发症进行了分析。 49 名患者收到了 MammoSite 近距离放射治疗的建议。 9 人拒绝，40 人入学，10 人因各种原因被排除（表 5）。总共 30 名患者在 5 天内实际接受了 34 Gy (2 x 3.4 Gy) 的治疗。我们在植入后 3 个月内观察到 3 例（10%）感染。 6 个月时有 5 名患者 (16.6%) 出现症状性血清肿，12 个月时有 3 名患者 (10%) 出现症状，18 个月时只有 1 名患者 (3.3%) 出现症状性血清肿。根据患者和医生的评价，75% 的人获得了良好至优秀的美容效果。使用 MammoSite 导管加速局部乳房照射可产生良好的短期效果、对皮肤的毒性作用有限以及最佳的美容效果。患者对治疗的耐受性非常高。关键问题可能涉及良好的腔体一致性和足够的球囊-皮肤距离对于避免皮肤可能出现的剂量过量的重要性。对于选定的患者群体，这可能是传统全乳房照射的有效替代方案。
Several studies have shown that the majority of in-breast recurrences following lumpectomy are at or near the original tumor site while ipsilateral breast recurrences further afield occur rarely. This suggests that the radiation dose could be delivered exclusively to the tumor bed, allowing larger fractions to be used without increasing toxicity and shortening the total treatment time. We investigated the use of the MammoSite irradiation system with a view to analyzing complications, cosmesis and patient comfort. Between 2004 and 2007 intracavity brachytherapy was given to 30 patients using the MammoSite device. The reference isodose was prescribed to the lumpectomy cavity with a 1 cm margin. Geometric parameters and anatomic position of the applicator after implantation were checked via CT, x-ray and ultrasound. Analysis was done for patient quality of life, cosmesis, early and late complications. Forty-nine patients received a proposal for MammoSite brachytherapy. Nine declined, 40 enrolled while 10 were excluded for various reasons (Table 5). A total of 30 patients were actually treated to 34 Gy (2 x 3.4 Gy) in 5 days. We observed 3 cases (10%) of infection within 3 months of implantation. Symptomatic seroma was seen in five patients (16.6%) at 6 months, in three (10%) at 12 months, and in just one patient (3.3%) at 18 months. Good to excellent cosmetic results were achieved in 75% by patient and physician ratings. Accelerated partial breast irradiation using the MammoSite catheter produces favorable short-term outcomes, limited toxic effects on skin, and optimal cosmetic results. Patient tolerance for the treatment is very high. Critical issues may regard the importance of good cavity conformance and adequate balloon-skin distance in avoiding possible dose excesses to the skin. For a selected patient group, this could be a valid alternative to conventional whole breast irradiation.