- 作者：Subarna Hamid ; Kathy Rocchio ; Douglas Arthur ; Robyn Vera ; S ; ra Sha ; Michele Jolly ; Sean Cavanaugh ; Eric Wooten ; Rashmi Benda ; Brad Greenfield ; Bradley Prestidge ; Scot Ackerman ; Robert Kuske ; Coral Quiet ; Margaret Snyder ; David E. Wazer
- 关键词：Breast cancer ; Boost ; Brachytherapy ; Noninvasive ; Cosmesis
- 刊名：International Journal of Radiation Oncology*Biology*Physics
- 出版年：2012
- 出版时间：1 August, 2012
- 年：2012
- 卷：83
- 期：5
- 页码：1374-1380
- 全文大小：634 K
Purpose
To evaluate the feasibility, implementation, and early results of noninvasive breast brachytherapy (NIBB) for tumor bed boost with whole breast radiation therapy (WBRT).Methods and Materials
NIBB is a commercially available (AccuBoost, Billerica, MA) mammography-based, brachytherapy system in which the treatment applicators are centered on the planning target volume (PTV) to direct 192Ir emissions along orthogonal axes. A privacy-encrypted online data registry collected information from 8 independent academic and community-based institutions. Data were from 146 consecutive women with early-stage breast cancer after lumpectomy and WBRT receiving boost with NIBB between July 2007 and March 2010. Toxicity and cosmesis were graded according to the Common Toxicity Criteria (v. 3.0) and the Harvard scale. Median follow-up was 6 months (1-39 months).
Results
Grade 1-2 skin toxicity was observed in 64 % , 48 % , and 21 % during the acute (1-3 weeks), intermediate (4-26 weeks), and late-intermediate (>26 weeks) periods. There was no Grade 4 toxicity. At 6 months, for the entire cohort, cosmesis was excellent/good in 62 % /38 % . The subset receiving NIBB before WBRT had cosmetic scores of 32 % and 63 % , whereas during WBRT, 58 % and 37 % were rated as excellent and good, respectively. Breast compression was scored as ¡°uncomfortable¡± in 12 % , 29 % , and 59 % when NIBB was delivered before, during, or after WBRT. For each patient, the fraction-to-fraction variability in PTV was low. Skin flash was associated with a higher proportion of excellent cosmesis (58 % vs. 42 % ) relative to having the applicator all within breast tissue.
Conclusions
These data indicate that NIBB is feasible and can be consistently implemented in a broad array of practice settings. Preliminary evaluation suggests that NIBB is associated with acceptably mild normal tissue toxicity and favorable early cosmesis. The application of NIBB before WBRT may be associated with better patient tolerance at the expense of less favorable cosmetic outcome.