术中定向放疗推量照射在乳腺癌保乳术中临床应用研究

doi:10.3969/j.issn.1009-976X.2020.06.01

摘要/Abstract

摘要： 目的研究乳腺癌保乳手术联合IntraBeam术中放疗系统进行术中靶向瘤床推量放射治疗的可行性、安全性、有效性及美容效果。方法共69例早期乳腺癌保乳手术患者接受了治疗,其中18.8%（13/69）患者年龄少于45岁,52.2%（36/69）肿物大于2 cm,40.6%（28/69）组织细胞学分级3级,29.0%（20/69）病人有淋巴结转移。病人保乳术后采用IntraBeam术中放疗系统瘤床表面20 Gy剂量进行术中靶向瘤床推量放射治疗,待化疗完成（或伤口愈合后）2周后给予传统全乳外照射放射疗治疗（50 Gy,共25次,省略瘤床推量照射）,评估患者近期疗效及不良反应。结果总共27.5%（19/69）患者出现急性并发症,2.9%（2/69）患者出现血肿,8.7%（6/69）出现血清肿,7.2%（5/69）出现切口感染,8.7%（6/69）切口愈合延迟,切口中位愈合时间3.8（1.0~11）个月,中位随访24.8个月（12~51）,2.9%（2/69）患者出现同侧乳房内复发,未出现远处转移及死亡病例,乳房美容效果评估优、良者术后1年占89.9%,术后2年占89.7%。结论乳腺癌保乳手术联合IntraBeam术中放疗系统进行术中靶向瘤床推量放射治疗近期疗效满意、不良反应较少,由于病人数量较少,随访时间较短,长远疗效仍需要进一步的验证。

关键词: 乳腺肿瘤, 保乳手术, 术中定向放疗推量照射, IntraBeam

Abstract: Objective To investigate the safety and feasibility and Cosmetic outcomes of targeted intraoperative radio Therapy Boost with INTRABEAM in breast conserving surgery for early breast cancer. Methods We treated 69 unselected patients for early-stage breast cancer. Thirteen patients （13/69, 18.8%） were younger than 45 years of age. More than half of the tumors （36/69, 52.2%） were > 2 cm. Twenty-eight （28/69, 41.0%） had a Grade 3 tumor and, in twenty （20/69, 29.0%） had axillary lymph nodes contained metastasis. After breast-conserving therapy, 20 Gy was delivered intraoperatively to the surface of the tumor bed, followed by external-beam radiotherapy （EBRT）, 50 Gy,25 times in total,but excluding the usual boost. The early overall survival,recurrence-free survival, and non-metastatic survival and cosmetic outcomes were short-term follow-up. Results Acute complications were observed in 27.5% （19/69） of patients and included 2.9% （2/69） hematomas that required drainage, 8.7%（6/69） seromas requiring drainage more than 3 times, 7.2% （5/69）infections treated with antibiotics or surgery, 8.7%（6/69）delayed wound healing and their average wound healing time was 3.8 （1.0-11.0） months. There During a median follow-up of 24.8 months （12-51）, 2.9 （2/69） of them developed local recurrence and there was no recurrence of distant metastasis or mortality. Cosmetic evaluation of breast in BCT with IORT group was carried out postoperative at points of one year and two years with 89.9% and 89.7% as excellent or fine cosmetic state respectively. Conclusion Targeted Intraoperative Radio Therapy Boost with INTRABEAM in breast conserving surgery for early-stage breast cancer is both safe and reliable, the long-term efficacy still needs to be further verified because of the small number of patients and short follow-up time.

Key words: breast neoplasms, breast-conserving surgery, targeted intraoperative radio therapy boost, IntraBeam

中图分类号:

R737.9

胡小戊, 章乐虹, 何咏, 陈欣欣, 夏婷, 曹腾飞, 贾海霞. 术中定向放疗推量照射在乳腺癌保乳术中临床应用研究[J]. 岭南现代临床外科, 2020, 20(06): 689-693.

HU Xiao-wu, ZHANG Le-hong, HE Yong, CHEN Xin-xin, XIA Ting, CAO Teng-fei, JIA Hai-xia. Targeted intraoperative radio therapy boost in breast conserving surgery for early breast cancer[J]. Lingnan Modern Clinics In Surgery, 2020, 20(06): 689-693.

参考文献

[1] Clarke M, Collins R, Dabby S, et al.Effects of radiotherapy and of differences in the extent of surgery for early breast cancer on local recurrence and 15-yearsurvival:an overview of the randomized trials[J]. Lancet, 2005, 366(9503): 2087-2106.
[2] Schnitt SJ, Connolly JL, Harris JR, et al.Pathologic predictors of early local recurrence in stage I and II breast cancer treated by primary radiation therapy[J]. Cancer, 1984, 53(5): 1049-1057.
[3] Fisher ER, Anderson S, Redmond C, Fisher B.Ipsilateral breast tumor recurrence and survival following lumpectomy and irradiation: pathological findings from NSABP protocol B-06[J]. Semin Surg Oncol, 1992, 8(3): 161-166.
[4] Veronesi U, Luini A, Del Vecchio M, et al.Radiotherapy after breast preserving surgery in women with localized cancer of the breast[J]. N Engl J Med, 1993, 328(22): 1587-1591.
[5] Vaidya JS, Vyas JJ, Chinoy RF, et al.Multicentricity of breast cancer: whole-organ analysis and clinical implications[J]. Br J Cancer, 1996, 74(5): 820-824.
[6] Baum M, Vaidya JS, Mittra I.Multicentricity and recurrence of breast cancer[J]. Lancet, 1997, 349(9046): 208.
[7] LeMasters TJ, Madhavan SS, Sambamoorthi U, Vyas AM. Disparities in the Initial Local Treatment of Older Women with Early-Stage Breast Cancer: A Population-Based Study[J]. J Womens Health (Larchmt), 2017, 26(7): 735-744.
[8] Deneve JL, Hoefer RA, Jr., Harris EE, Laronga C. Accelerated partial breast irradiation: a review and description of an early North American surgical experience with the intrabeam delivery system[J]. Cancer Control, 2012, 19(4): 295-308.
[9] Keshtgar MR, Williams NR, Bulsara M, et al.Objective assessment of cosmetic outcome after targeted intraoperative radiotherapy in breast cancer: results from a randomised controlled trial[J]. Breast Cancer Res Treat, 2013, 140(3): 519-525.
[10] Dutta SW, Showalter SL, Showalter TN, et al.Intraoperative radiation therapy for breast cancer patients: current perspectives [J]. Breast Cancer (Dove Medical Press), 2017, 9: 257-263.
[11] Vaidya JS, Baum M, Tobias JS, et al.Targeted intra-operative radiotherapy (Targit): an innovative method of treatment for early breast cancer[J]. Ann Oncol, 2001, 12(8): 1075-1080.
[12] Veronesi U, Orecchia R, Luini A, et al.Full-dose intra-operative radiotherapy with electrons (ELIOT) during breast-conserving surgery: experience with 1246 cases[J]. Ecancermedicalscience, 2008, 2: 65.
[13] Piotrowski I, Kulcenty K, Wichtowski M, et al.Intraoperative Radiotherapy of Breast Cancer and Its Biological Effects[J]. Breast care (Basel, Switzerland), 2017, 12(2): 109-113.
[14] Sperk E, Welzel G, Keller A, et al.Late radiation toxicity after intraoperative radiotherapy for breast cancer: resules from the randomized phase 3 trail TARGIT-A[J]. Breast Cancer Ret Treat, 2012, 13(1): 253-260.
[15] Veronesl U, Orecchia R, Luini A, et al.Intraoperative radiotherapy during breast conserving surgery: a study on 1,882 case treated with electrons[J]. Breast Cancer Ret Treat, 2010, 124(1): 141-151.
[16] Polgar C, Van Limbergen E, Potter R, et al.Patient selection for accelerated partial-breast irradiation (APBI) after breastconserving surgery: recommendations of the Groupe Europeen de Curietherapie-European Society for Therapeutic Radiology and Oncology (GEC-ESTRO) breast cancer working group based on clinical evidence[J]. Radiother Oncol, 2009, 94(3): 264-273.
[17] Kim J, Yoo J, Lee J, et al.Oncoplastic reconstruction with superior based lateral breast rotation flap after lower quadrant tumor resection[J]. J Breast Cancer, 2012, 15(3): 350-355.
[18] Veronesi U, Orecchia R, Luini A, et al.Intraoperative radiotherapy during breast conserving surgery: a study on 1,822 cases treated with electrons[J]. Breast Cancer Res Treat, 2010, 124(1): 141-151.
[19] Wenz F, Welzel G, Blank E, et al.Intraoperative radiotherapy as a boost during breast-conserving surgery using low-kilo voltage X-rays: the first 5 years of experience with a novel approach[J]. Int J Radiat Oncol Biol Phys, 2010, 77(5): 1309-1314.
[20] Ivaldi GB, Leonardi MC, Orecchia R, et al.Preliminary results of electron intraoperative therapy boost and hypofractionated external beam radiotherapy after breast-conserving surgery in premenopausal women[J]. Int J Radiat Oncol Biol Phys, 2008, 72(2): 485-493.
[21] Sedlmayer F, Fastner G, Merz F, et al.IORT with electrons as boost strategy during breast conserving therapy in limited stage breast cancer: results of an ISIORT pooled analysis[J]. Strahlenther Onkol, 2007, 183(2): 32-34.
[22] Vaidya JS, Baum M, Tobias JS, et al.Targeted intraoperative radiotherapy (TARGIT) yields very low recurrence rates when given as a boost[J]. Int J Radiat Oncol Biol Phys, 2006, 66(5): 1335-1338.
[23] Chang DW, Marvelde L, Chua BH.Prospective study of local controland late radiation toxicity after intraoperative radiation therapy boost for early breast cancer[J]. Int J Radiat Oncol Biol Phys, 2014, 88(1): 73-79.
[24] 张保宁, 邵志敏, 乔新民, 等. 中国乳腺癌保乳治疗的前瞻性多中心研究[J]. 中华肿瘤杂志, 2005, 27(11): 680-684.
[25] Mazor AM, Mateo AM, Demora L, et al.Breast conservation versus mastectomy in patients with T3 breast cancers (>5 cm): an analysis of 37,268 patients from the National Cancer Database[J]. Breast Cancer Res Treat, 2019, 173(2): 301-311.
[26] 朱见, 贺青卿, 郑鲁明, 等. INTRABEAM放疗系统在乳腺癌保乳术中应用研究[J]. 中华内分泌外科杂志, 2017, 11(2): 97-100.
[27] Jacobs DHM, Speijer G, Petoukhova AL, et al.Acute toxicity of intraoperative radiotherapy and external beam-accelerated partial breast irradiation in elderly breast cancer patients[J]. Breast Cancer Res Treat, 2018, 169(3): 549-559.
[28] 刘军, 黄林平, 周伟. 术中放疗在早期乳腺癌保乳手术中的应用观察[J]. 中日友好医院学报, 2016, 30(3): 137-140.
[29] Tenofsky PL, Dowell P, Topalovski T, Helmer SD.Surgical, oncologic, and cosmetic diferences between oncoplastic and nononcoplastic breast conserving surgery in breast cancer patients[J]. Am J Surg, 2014, 207(3): 398-402.