两种算法在宫颈癌术后调强放疗中的剂量学比较研究

目的: 比较蒙特卡罗算法与筒串卷积算法在宫颈癌术后调强放射治疗中的剂量学差异。方法: 随机选择25例宫颈癌术后行调强放疗患者,对同一治疗计划分别用两种算法进行剂量计算,通过剂量体积直方图的剂量体积参数比较两者靶区和危及器官的剂量学差异。结果: 靶区D₉₈、D₂、D₅₀、HI蒙特卡罗算法结果低于筒串卷积算法（P﹤0.05）;CI结果高于筒串卷积法（P﹤0.05）。膀胱V₃₀、V₄₀,直肠V₄₀、D₅₀,股骨头、盆骨V₃₀、V₄₀、D₅₀,脊髓D₂、D₅₀蒙特卡罗算法结果低于筒串卷积算法;靶区CI、结肠V₃₀、V₄₀、D₅₀ 蒙特卡罗算法结果高于筒串卷积算法,以上结果差异均具有统计学意义（P﹤0.05）。结论: 宫颈癌术后调强放射治疗,优先选择蒙特卡罗算法进行计划设计,同时应适当充盈膀胱,减少小肠、结肠卷入射野的体积;如果只能选用筒串卷积算法,应适当增大最小子野面积,减少子野数量。     

乳腺癌的术中放疗

乳腺癌是全球女性最高发的恶性肿瘤,不仅威胁患者生命,同时也影响患者的生存质量和生理功能。因此,采用优化的综合治疗策略,延长患者生命,改善患者生存质量,是目前乳腺癌治疗的趋势。放射治疗是乳腺癌综合治疗的重要组成部分,近年来,乳腺癌放射治疗具有照射范围缩小,分割次数减少两大趋势。术中放疗(intraoperative radiotherapy,IORT)由于在手术中直视下给予单次大剂量照射,具有缩短疗程,有效保护正常组织的优势。目前IORT对接受保乳术的乳腺癌患者可作为外照射的局部剂量追加技术方法,或作为替代术后外照射的技术方法。现就IORT技术的优缺点及其临床适应证、疗效和不良反应进行系统回顾,为指导临床开展IORT提供依据。     

乳腺癌术后放疗H-IMRT技术与H-VMAT技术剂量学比较

目的 比较基于IMRT的混合调强计划(H-IMRT)与基于VMAT的混合容积调强计划(H-VMAT)在左侧乳腺癌根治术后(胸壁+锁骨上+內乳区)放射治疗计划的剂量学参数,为复杂的乳腺癌术后放疗计划设计提供一定的参考。方法 选取我院2018年1月—2020年12月,20例左侧乳腺癌根治术后患者。所有患者胸壁、锁骨上淋巴结、内乳淋巴结均需要接受放射治疗,每个患者分别设计制作H-IMRT与H-VMAT两种放疗计划。CRT射野对胸廓方向进行2cm的多叶准直器(MLC)外放。靶区处方剂量50Gy,通过剂量计算比较靶区和危及器官的剂量参数。结果 H-IMRT计划靶区均匀性指数为(0.13±0.06),适形指数为(1.33±0.08)。H-VMAT计划靶区均匀性指数为(0.12±0.04),适形指数为(1.24±0.07)。H-VMAT计划中靶区均匀性指数和适形指数均高于H-IMRT计划(P＜0.05)。H-IMRT计划患肺V₅(48.99±2.91)%、V₂₀(24.5±1.1)%,H-VMAT计划患肺V₅(45.87±3.53)%、V₂₀(20.6±1.6)%,H-VMAT计划患肺V₅和V₂₀剂量均低于H-IMRT计划(P＜0.05)。H-IMRT计划心脏V₃₀(10.44±3.62)%、V₄₀(6.59±3.53)%,H-VMAT计划心脏V₃₀(5.87±1.53)%、V₄₀(4.9±2.8)%,H-VMAT计划心脏V₃₀和V₄₀均低于H-IMRT计划(P＜0.05)。H-IMRT计划心脏D_mean(7.43±1.78)Gy,H-VMAT计划心脏D_mean(9.7±0.7)Gy,H-VMAT计划略高于H-IMRT计划(P＜0.05)。结论 对于带有內乳淋巴结的乳腺癌术后放疗靶区,H-VMAT对比H-IMRT靶区适形度更好,危及器官受照剂量更低。     

MRI指导骨髓保护IMRT对直肠癌同期放化疗血液不良反应影响

目的 通过IMRT降低直肠癌患者放疗区域造血活性骨髓的受照射剂量,以其减轻在同期放化疗期间的急性血液不良反应。方法 前瞻性入组直肠癌初治患者,根据盆腔核磁图像确定造血活性骨髓分布并勾画,并对其进行剂量限定(V₅<95%,V₁₀<90%,V₂₀<80%,V₃₀<65%),新辅助治疗方案为IMRT同期化疗(95%PTV₅₀ Gy分25次,2 Gy/次),同期每周奥沙利铂50 mg/m²,卡培他滨每天1650 mg/m²(放疗期间每天2次)。结果 共 35例Ⅱ、Ⅲ期患者完成入组和治疗方案。2-4级血液学不良反应发生率为31%,其中白细胞减少发生率为26%(9例)、中性粒细胞减少发生率为17%(6例)、红细胞减少发生率为3%(1例)、血小板减少发生率为3%(1例)。多元Logistic线性回归分析表明造血活性骨髓 V₅与白细胞、中性粒细胞和血小板最低值均显著相关(P=0.005、0.002、0.017)。结论 根据MR确定的骨盆造血活性骨髓受量与直肠癌患者新辅助同期放化疗急性血液不良反应发生率和严重程度明显相关。临床试验注册 ClinicalTrials.gov,注册号:NCT01863420。     

乳腺癌改良根治术后胸壁和区域淋巴引流区整体化调强放疗剂量学与不良反应分析

目的 探讨乳腺癌改良根治术后胸壁和区域淋巴引流区整体化调强放疗(IMRT)技术的剂量学特点,并观察照射后的急性不良反应。方法 对75例乳腺癌患者(左侧乳腺癌41例)以治疗位行计划CT扫描,在CT上将胸壁和锁骨上淋巴引流区加或不加内乳区作为整体勾画。针对整个靶区整体或分段设计IMRT计划,处方剂量50 Gy至少包绕90%计划靶体积(PTV),PTV包含内乳区者31例。用靶区和正常组织体积-剂量评价治疗计划,并观察计划实施后的急性不良反应。整体计划与分段计划的剂量学参数比较行成组t检验。结果 全组患者均完成计划设计和放疗,PTV适形指数、均匀指数分别为1.43、0.14,PTV包含内乳区者均匀指数较高,110%处方剂量PTV体积均<5%,正常组织实际剂量均未超出限值。整体计划(55例)与分段计划(20例)比较,其D_max、D_mean、V_107%和V_110%均不同(t=2.19~2.53,P=0.013~0.031)。32例发生≥2级皮炎,其中2级22例、3级10例;发生部位以腋窝前皱褶最为常见,多数发生于放疗后1~2周。仅2例发生2级肺炎。     

乳腺癌保留术后瘤床追加剂量的弧形野技术

目的:利用弧形野技术提高乳腺瘤床靶区照射剂量,减少肺组织和乳腺正常组织的照射剂量和容积,作乳腺癌保留术后瘤床追加剂量技术与方法的探讨.方法:用大恒STAR-2000三维放射治疗计划系统、GE双螺旋CT、VARIAN 600C/D直线加速器对乳腺癌保留术后患者实施精确定位、虚拟计划设计、弧形野技术照射.结果:通过三维治疗计划的剂量显示,乳腺瘤床靶区100%体积肿瘤剂量≥90%,剂量分布符合临床要求.结论:使用弧形野技术照射乳腺癌,能够有效提高乳腺瘤床靶区肿瘤剂量及要求≥90%的等剂量线包括靶区,减少肺组织、心脏和正常乳腺组织的照射剂量.     

乳腺癌保乳术后全乳预防性照射的靶区勾画范围

目的 探讨乳腺癌保乳术后全乳预防性照射的靶区勾画范围。方法 选取149例乳腺癌患者,均进行MRI检查,记录乳腺癌病灶位置。选取其中10例左乳腺癌且采取保乳术的患者,分别进行全乳房靶区勾画和乳腺腺体靶区勾画,比较两种靶区勾画方法的剂量学参数。结果MRT检查显示,149例患者的乳腺癌病灶均位于乳腺腺体内或乳腺腺体边缘,没有患者的乳腺癌病灶独立发生于乳腺腺体外的脂肪组织内。乳腺腺体靶区勾画的照射体积、心脏平均剂量、左肺V₂₀均明显低于全乳房靶区勾画,差异均有统计学意义(P<0.01)。结论 在对保乳术后患者进行全乳预防性照射时,除原发灶部位需要外扩以降低复发风险外,靶区勾画应仅限于影像学上可见的残余乳腺腺体,无需涵盖整个乳房,从而减少全乳腺照射体积,降低肺部和心脏照射剂量,对部分乳腺癌患者的长期生存有益。     

乳腺癌保乳术后全乳及锁骨上下区三种调强剂量学分析

目的 比较乳腺癌保乳术后全乳及锁骨上下区同时照射的固定野静态IMRT、固定野动态IMRT (DMLC)与VMAT的剂量学差异。 方法 选择2012—2015年本院女性乳腺癌患者 14例,照射范围包括胸壁及锁骨上下区。每例患者分别设计3种计划并使用相同优化条件,以DVH为依据比较PTV及OAR剂量。采用单因素方差分析或非参数Wilcoxon符号秩检验。 结果 IMRT、DMLC、VMAT三者的 V₉₅、V₉₈、CI、HI值组间比较结果均为VMAT最优(P<0.009)。患侧肺 V₅、V₂₀及 D_mean值,健侧肺 V₅及 D_mean值VMAT计划值均最优(P<0.022)。脊髓平均剂量VMAT最低(P=0.004)。 结论 对于全乳及锁骨上下区的乳腺癌患者治疗方式首选VMAT,在能保证靶区剂量的同时有效控制正常组织受量,减轻放疗并发症的风险。     

乳腺癌保乳术后螺旋断层治疗技术的剂量学研究

目的 研究乳腺癌保乳术后患者应用固定野调强放疗(FF-IMRT)和螺旋断层治疗(HT)计划的剂量学差异。方法 选择10例左侧乳腺癌保乳术后IMRT患者,CT模拟定位、勾画靶区及危及器官,对同一CT图像设计FF-IMRT计划和HT计划。配对t检验两种计划靶区及危及器官剂量分布及照射时间差异。结果 与FF-IMRT计划相比,HT计划的100%PTV覆盖度增加(P=0.000),105%PTV覆盖度降低(P=0.000),平均剂量(D_mean)降低(P=0.002),均匀指数(HI)、适形指数(CI)增加(P=0.001、0.023)。HT计划的患侧肺剂量体积V₅、V₁₀、V₂₀、V₃₀、V₄₀、D_mean分别降低28%、30%、35%、46%、61%、32%(P=0.000),双肺的分别降低30%、28%、34%、46%、62%、26%(P=0.000),心脏的和最大剂量(D_max)分别降低57%、59%、71%、82%、91%、45%和12%(P=0.000~0.002),健侧乳腺D_mean、D_max分别增加0.9、3.0 Gy (P=0.000、0.000),健侧肺的分别增加0.42、2.70 Gy (P=0.000、0.000)。HT计划照射时间明显高于FF-IMRT计划(11.98 min:5.96 min,P=0.000)。结论 左侧如乳腺癌HT计划的靶区均匀性和适形度均优于FF-IMRT计划,危及器官可获得等同于或优于FF-IMRT计划的剂量分布,可作为新照射方式用于乳腺癌保乳术后患者。     

基于TrueBeam平台设计左乳腺癌术后放疗VMAT计划

目的 探索一种基于TrueBeam直线加速器平台的快速简捷的乳腺癌容积旋转调强放疗(VMAT)计划设计的方法,旨在降低乳腺癌VMAT计划设计难度和降低危及器官剂量。方法 选择广州中医药大学金沙洲医院2020-05-11-2022-03-01的收治24例左乳腺癌术后深吸气屏气放疗病例(靶区仅包含胸壁区和锁骨区),在Varian的Eclipse 15.6计划系统上,勾画特定的辅助结构,设置4条子弧,使用基本固定的优化条件重新设计得到左乳腺癌VMAT计划(VMAT＿limit)。并将该计划与原TrueBeam临床治疗的VMAT计划(VMAT＿clinic)进行比较,其中包括靶区适形性指数(CI)、均匀性指数(HI)、靶区最大点剂量(D_max)、危及器官平均剂量(D_mean)、脊髓、肺、心脏的剂量以及机器总跳数(MU)。结果 与VMAT＿clinic相比,VMAT＿limit的左肺V₁₀体积降低了7.09%(Z=-4.13,P<0.001)、左肺V₅体积降低了10.93%(Z=-4.804,P<...     

A preliminary report of intraoperative radiotherapy (IORT) in limited-stage breast cancers that are conservatively treated

Local recurrences after breast conserving surgery occur mostly in the quadrant harbouring the primary carcinoma. The main objective of postoperative radiotherapy should be the sterilisation of residual cancer cells in the operative area, while irradiation of the whole breast may be avoided. We have developed a new technique of intra-operative radiotherapy (IORT) of a breast quadrant after the removal of the primary carcinoma. A mobile linear accelerator (linac) with a robotic arm is utilised delivering electron beams able to produce energies from 3 to 9 MeV. Through a perspex applicator, the radiation is delivered directly to the mammary gland and to spare the skin from the radiation, the skin margins are stretched out of the radiation field. To protect the thoracic wall, an aluminium-lead disc is placed between the gland and the pectoralis muscle. Different dose levels were tested from 10 to 21 Gy without important side-effects. We estimated that a single fraction of 21 Gy is equivalent to 60 Gy delivered in 30 fractions at 2 Gy/fraction. Seventeen patients received a dose of IORT of 10 to 15 Gy as an anticipated boost to external radiotherapy, while 86 patients received a dose of 17–19–21 Gy intra-operatively as their whole treatment. The follow-up time of the 101 patients varied from 1 to 17 months (mean follow-up time was 8 months). The IORT treatment was very well accepted by all of our patients, either due to the rapidity of the radiation course in cases where IORT was given as the whole treatment or to the shortening of the subsequent external radiotherapy in cases where IORT was given as an anticipated boost. We believe that single dose IORT after breast resection for small mammary carcinomas may be an excellent alternative to the traditional postoperative radiotherapy. However, a longer follow-up is needed for a better evaluation of the possible late side-effects.     

Evaluating the role of intra-operative radiation therapy in the modern management of breast cancer

Over the last 10 years, intra-operative radiotherapy (IORT) has been used extensively in the clinical trial setting but has yet to make a significant clinical impact on current breast cancer management strategies. This review discusses the rationale behind IORT, the benefits and limitations of this technique over conventional whole breast radiation (WBRT), and the indications, contraindications, and appropriate patient selection criteria. In addition, the most up-to-date trial data and the role of IORT in future breast cancer management strategies are discussed.     

Long-term toxicity of an intraoperative radiotherapy boost using low energy X-rays during breast-conserving surgery

PURPOSE: Intraoperative radiotherapy (IORT) as a boost for breast cancer delivers a high single dose of radiation to a late-reacting tissue; therefore late toxicity is of particular interest, and long-term follow-up is warranted. To date there are only limited data available on breast cancer patients treated with IORT using low energy X-rays. We analyzed toxicity and cosmesis after IORT as a boost with a minimum follow-up of 18 months. METHODS AND MATERIALS: A total of 73 patients treated with IORT (20 Gy/50 kV X-rays; INTRABEAM [Carl Zeiss Surgical, Oberkochen, Germany]) to the tumor bed during breast-conserving surgery as a boost followed by whole-breast radiotherapy (WBRT, 46 Gy) underwent a prospective, predefined follow-up (median, 25 months; range 18-44 months), including clinical examination and breast ultrasound at 6-months and mammographies at 1-year intervals. Toxicities were documented using the common toxicity criteria (CTC)/European Organization for Research and Treatment of Cancer and the LENT-SOMA score. Cosmesis was evaluated with a score from 1 to 4. RESULTS: The IORT in combination with WBRT was well tolerated, with no Grade 3 or 4 skin toxicities and no telangiectasias. Fibrosis of the entire breast was observed in 5% of the patients. A circumscribed fibrosis around the tumor bed was palpable in up to 27% with a peak around 18 months after therapy and a decline thereafter. The observed toxicitiy rates were not influenced by age, tumor stage, or systemic therapy. The cosmetic outcome was good to excellent in>or=90% of cases. CONCLUSIONS: After IORT of the breast using low-energy X-rays, no unexpected toxicity rates were observed during long-term-follow-up.     

Intraoperative radiotherapy (IORT) for breast cancer using the Intrabeam system

INTRODUCTION: Intraoperative radiotherapy (IORT) with low-energy X-rays (30-50 KV) is an innovative technique that can be used both for accelerated partial breast irradiation (APBI) and intraoperative boosting in patients affected by breast cancer. Immediately after tumor resection the tumor bed can be treated with low-distance X-rays by a single high dose. Whereas often a geographic miss in covering the boost target occurs with external beam boost radiotherapy (EBRT), the purpose of IORT is to cover the tumor bed safely. This report will focus on the feasibility and technical aspects of the Intrabeam device and will summarize our experience with side effects and local control. MATERIALS AND METHODS: Between February 2002 and June 2003 57 breast cancer patients, all eligible for breast conserving surgery (BCS), were treated at the Mannheim Medical Center with IORT using the mobile X-ray system Intrabeam. The patient population in this feasibility study was not homogeneous consisting of 49 patients with primary stage I or II breast cancer, seven with local recurrence after previous EBRT and one with a second primary in a previously irradiated breast. The selection criteria for referral for IORT included tumor size, tumor cavity size, margin status and absence of an extensive intraductal component. The previously irradiated patients with local recurrences and 16 others received IORT as single modality. In all other cases IORT was followed by EBRT with a total dose of 46 Gy in 2-Gy fractions. The intraoperatively delivered dose after tumor resection was 20 Gy prescribed to the applicator surface. EBRT was delivered with a standard two-tangential-field technique using linear accelerators with 6- or 18-MV photons. Patients were assessed every three months by their radiation oncologist or surgeon during the first year after treatment and every six months thereafter. Breast ultrasound for follow-up was done every six months and mammographies once yearly. Acute side effects were scored according to the CTC/EORTC score and late side effects according to the Lent-Soma classification. RESULTS: Twenty-four patients received IORT only; eight patients because they had received previous radiotherapy, 16 because of a very favorable risk profile or their own preference. Thirty-three patients with tumor sizes between 1 and 30 mm and no risk factors were treated by IORT as a boost followed by EBRT. The Intrabeam system was used for IORT. The Intrabeam source produces 30-50 KV X-rays and the prescribed dose is delivered in an isotropic dose distribution around spherical applicators. Treatment time ranged between 20 and 48 minutes. No severe acute side effects or complications were observed during the first postoperative days or after 12 months. One local recurrence occurred 10 months after surgery plus IORT followed by EBRT. In two patients distant metastases were diagnosed shortly after BCS. DISCUSSION: IORT with the Intrabeam system is a feasible method to deliver a single high radiation dose to breast cancer patients. As a preliminary boost it has the advantage of reducing the EBRT course by 1.5 weeks, and as APBI it might be a promising tool for patients with a low risk of recurrence. The treatment is well tolerated and does not cause greater damage than the expected late reaction in normal tissue.     

Partial irradiation of the breast: why, how?]

Radiation therapy represents a very important part of breast conservative treatment. The classic schedule consists in delivering a total dose of 50 Gy in 25 fractions on 5 weeks, sometimes associated with a 10 to 16 Gy boost. For elderly women with difficulties to move or for younger women having professional activity or with young children in charge, a 5 to 6 weeks radiation therapy with long and frequent transportations is sometimes difficult to achieve. The aim of partial breast irradiation (PBI) is to prevent, in a short period (5 to 8 days) and less transportations, the risk of local recurrence into the tumor bed. Different techniques have been described, using either interstitial brachytherapy (low or high dose rate) or intra-operative radiation therapy (IORT photons or electrons) or external beam radiation therapy. Phase II PBI trials using interstitial brachytherapy showed a local control rate of 0 to 4% with a follow-up of 20 to 75 months. The rate of good/excellent cosmetic results is 67 to 100%. Results analysis of trials using very new PBI techniques (MammoSite), IORT) remains more difficult. If phase III randomized trials could confirm that PBI achieved, for selected patients, local controls equivalent to those obtain with whole breast irradiation, PBI could improve quality of life during radiation therapy, and maybe contribute to have a cost effective breast cancer conservative treatment.     

Non-coplanar Volumetric Modulated Arc Therapy for Locoregional Radiotherapy of Left-sided Breast Cancer Including Internal Mammary Nodes

BackgroundNon-coplanar volumetric modulated arc therapy (ncVMAT) is proposed to reduce toxicity in heart and lungs for locoregional radiotherapy of left-sided breast cancer, including internal mammary nodes (IMN).Patients and methodsThis retrospective study included 10 patients with left-sided breast cancer who underwent locoregional radiotherapy after breast-conserving surgery. For each patient, the ncVMAT plan was designed with four partial arcs comprising two coplanar arcs and two non-coplanar arcs, with a couch rotating to 90°. The prescribed dose was normalized to cover 95% of planning target volume (PTV), with 50 Gy delivered in 25 fractions. For each ncVMAT plan, dosimetric parameters were compared with the coplanar volumetric modulated arc therapy (coV-MAT) plan.ResultsT here were improvements in conformity index, homogeneity index and V₅₅ of total target volume (PTVall) comparing ncVMAT to coVMAT (p < 0.001). Among the organs at risk, the average V₃₀, V₂₀, V₁₀, V₅, and mean dose (D_mean) of the heart decreased significantly (p < 0.001). Furthermore, ncVMAT significantly reduced the mean V₂₀, V₁₀, V₅, and D_mean of left lung and the mean V₁₀ and V₅ and D_mean of contralateral lung (p < 0.001). An improved sparing of the left anterior descending coronary artery and right breast were also observed with ncVMAT (p < 0.001).ConclusionsCompared to coVMAT, ncVMAT provides improved conformity and homogeneity of whole P TV, better dose sparing of the heart, bilateral lungs, left anterior descending coronary artery (LAD), and right breast for locoregional radiotherapy of left-sided breast cancer with IMN, potentially reducing the risk of normal tissue damage.Key words: non-coplanar, volumetric, modulated arc therapy, left-sided breast cancer, internal mammary nodes     

Intraoperative radiotherapy given as a boost for early breast cancer: long-term clinical and cosmetic results

PURPOSE: The standard radiotherapy (RT) of breast cancer consists of 50 Gy external beam RT (EBRT) to the whole breast followed by an electron boost of 10-16 Gy to the tumor bed, but this has several cosmetic disadvantages. Intraoperative radiotherapy (IORT) could be an alternative to overcome these. METHODS AND MATERIALS: We evaluated 50 women with early breast cancer operated on in a dedicated IORT facility. Median dose of 10 Gy was delivered using 9-MeV electron beams. All patients received postoperative EBRT (50 Gy in 2 Gy fractions). Late toxicity and cosmetic results were assessed independently by two physicians according to the Common Terminology Criteria for Adverse Event v3.0 grading system and the European Organization for Research and Treatment of Cancer questionnaires. RESULTS: After a median follow-up of 9.1 years (range, 5-15 years), two local recurrences were observed within the primary tumor bed. At the time of analysis, 45 patients are alive with (n = 1) or without disease. Among the 42 disease-free remaining patients, 6 experienced Grade 2 late subcutaneous fibrosis within the boost area. Overall, the scores indicated a very good quality of life and cosmesis was good to excellent in the evaluated patients. CONCLUSION: Our results confirm that IORT given as a boost after breast-conserving surgery is a reliable alternative to conventional postoperative fractionated boost radiation.     

Clinical analysis of intraoperative radiotherapy during breast-conserving surgery of early breast cancer in the Chinese Han population

Purpose

While results of intraoperative radiotherapy (IORT) during breast-conserving surgery (BCS) have been reported when used either as a boost at the time of surgery or as the sole radiation treatment, the clinical safety and cosmetic outcome of IORT in the Chinese Han population has not. This report reviews oncologic and cosmetic outcomes for Chinese Han breast cancer patients who received IORT either as a boost or as their sole radiation treatment at our hospital.

Method

From July 2008 to December 2012, 50 early-stage Chinese Han breast cancer patients received BCS and IORT, either as boost or as their sole radiation treatment. Patients received adjuvant chemotherapy or hormonal therapy, according to our institution''s guidelines. Patients were followed to determine oncologic events, short-term toxicity and overall cosmesis.

Results

With a median follow-up of 51.8 months (range 22.6 months to 75.7 months), 2 patients (4.0%) developed local relapses and were salvaged by mastectomy. There were no metastases and no deaths. The average wound healing time was 17 days. Three patients (6.0%) developed postoperative infection, 5 patients (10.0%) had delayed wound healing, and 2 patients (4.0%) experienced wound edema. There were no lyponecrosis or hematomas observed. The evaluation of cosmetic outcome showed 44 patients (88.0%) graded as excellent or good while 6 patients (12.0%) were graded as fair or poor. No patients experienced radiotherapy related acute hematological toxicity, but 3 patients (6.0%), all IORT boost patients, developed skin pigmentation.

Conclusion

For early-stage breast cancer patients, intraoperative radiotherapy after breast-conserving surgery in the Chinese Han population is both safe and reliable and has resulted in very acceptable cosmetic outcomes.     

保留乳头乳晕复合体的乳腺癌切除术中放疗的地位探讨

在乳腺癌切除术的术式选择中,保留乳头乳晕复合体(nipple-areola complex,NAC)的乳房切除术(nipple-areola complex-sparing mastectomy,NSM)保留了皮肤和NAC,从而有利于后期的重建。目前在NSM治疗中,有几个关键问题尚未达成统一共识,包括NSM术中或术后是否加用或联合局部放疗,最终指向保留NAC后的肿瘤复发的安全性即术后局部复发率问题。有研究报道,不管是术后放疗还是术中放疗,联合NSM都能降低局部复发率,然而,对比联合放疗的研究和未放疗的研究,显示NSM后局部复发率相似,因此从整个NSM的治疗原则出发,患者的选择和手术质控是整个治疗的关键,对于不同复发风险的患者需要采取不同的联合放疗的方案。     

Efficacy and safety of intraoperative radiotherapy in breast cancer: a systematic review

The objective of this study is to assess the efficacy and safety of intraoperative radiotherapy (IORT) for early breast cancer through a systematic review. Fifteen studies met the inclusion criteria. Most studies assessed the combined treatment with IORT (10-24 Gy) and external beam radiotherapy (EBRT) (45-50 Gy) on early stage breast cancer (T_0-2). Local control was over 95% for 1 and 4 years of follow-up and the 5-year overall survival was 99%. The TARGIT-A study found a similar survival comparing IORT with standard treatment. The incidence of acute and chronic complications was scarce. IORT is well tolerated by patients and acute and late toxicities are low. There are no differences in survival for IORT treated patients versus standard treatment.