BACKGROUND: The optimal radiotherapy technique for cardiac sparing in left-sided early breast cancer (EBC) is not clear. In this context, the aim of our dosimetric study was to compare cardiac and lung doses according to the type of radiotherapy - whole breast irradiation (WBI), external partial breast irradiation (PBI), and multicatheter interstitial brachytherapy-accelerated partial breast irradiation (MIB-APBI). The dosimetric results with the WBI and PBI were calculated with and without DIBH. MATERIALS AND METHODS: Dosimetric study of 23 patients treated with WBI, PBI, with and without DIBH, or MIB-APBI. The prescribed dose was 40 Gy in 15 fractions for WBI and PBI and 34 Gy in 10 fractions (bid) for MIB-APBI. Doses to the organs-at-risk (OAR) - heart, left anterior descending coronary artery (LAD), left ventricle (LV), and left lung - were recalculated to the equivalent dose in 2-Gy fractions (EQD2). RESULTS: The addition of DIBH significantly reduced EQD2 doses to all OARs (except for the left lung maximal dose) in WBI and PBI. MHD values were 0.72 Gy for DIBH-WBI, 1.01 Gy for MIB-APBI and 0.24 Gy for DIBH-PBI. There were no significant differences in cardiac doses between WBI with DIBH and PBI without DIBH. DIBH-PBI resulted in significantly lower mean doses to all OARs (except for maximum lung dose) compared to MIB-APBI. Conclusions: These results show that the use of DIBH significantly reduces cardiac doses in patients with left EBC. Partial irradiation techniques (PBI, MIB-APBI) significantly reduced cardiac doses due to the smaller clinical target volume. The best results were obtained with DIBH-PBI.
- Publikační typ
- časopisecké články MeSH
PURPOSE: To quantify mean heart dose (MHD) and doses to the left anterior descending artery (LAD) and left ventricle (LV) in a retrospective series of patients who underwent perioperative accelerated partial breast irradiation with multicatheter interstitial brachytherapy (MIB-APBI). METHODS: Sixty-eight patients with low-risk left breast cancer were treated with MIB-APBI at our institution between 2012 and 2017. Interstitial tubes were inserted during the tumorectomy and sentinel node biopsy and APBI was started 6 days later. The prescribed dose was 34 Gy in 10 fractions (twice a day) to the clinical target volume (CTV). The heart, LAD, and LV were contoured and the distance between each structure and the CTV was measured. The MHD, mean and maximum LAD doses (LAD mean/max), and mean LV doses (LV mean) were calculated and corrected to biologically equivalent doses in 2‑Gy fractionation (EQD2). We also evaluated the impact of the distance between the cardiac structures and the CTV and of the volume receiving the prescribed dose (V100) and high-dose volume (V150) on heart dosimetry. RESULTS: Mean EQD2 for MHD, LAD mean/max, and mean LV were 0.9 ± 0.4 Gy (range 0.3-2.2), 1.6 ± 1.1 Gy (range, 0.4-5.6), 2.6 ± 1.9 Gy (range, 0.7-9.2), and 1.3 ± 0.6 Gy (range, 0.5-3.4), respectively. MHD, LAD mean/max, and LV mean significantly correlated with the distance between the CTV and these structures, but all doses were below the recommended limits (German Society of Radiation Oncology; DEGRO). The MHD and LV mean were significantly dependent on V100. CONCLUSION: Perioperative MIB-APBI resulted in low cardiac doses in our study. This finding provides further support for the value of this technique in well-selected patients with early-stage left breast cancer.
- MeSH
- brachyterapie metody MeSH
- celková dávka radioterapie MeSH
- lidé středního věku MeSH
- lidé MeSH
- nádory prsu radioterapie MeSH
- prsy účinky záření MeSH
- retrospektivní studie MeSH
- srdce účinky záření MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
PURPOSE: To assess the feasibility of high-dose-rate perioperative multicatheter interstitial brachytherapy to deliver accelerated partial breast irradiation (APBI) in selected patients with early breast cancer. METHODS AND MATERIALS: Perioperative multicatheter interstitial brachytherapy for APBI has been used at our department since 2012 for patients with low-risk breast cancer. Interstitial catheters were inserted perioperatively via hollow needles immediately following tumorectomy with sentinel node biopsy. APBI started on Day 6 after surgery. The prescribed dose was 34 Gy (10 fractions of 3.4 Gy bid). Hormonal therapy was prescribed in all cases. RESULTS: Between June 2012 and December 2017, 125 patients were scheduled for APBI. Of these, APBI was not performed in 12 patients (9.6%) due to adverse prognostic factors identified on the definitive biopsy. We observed wound dehiscence in 2/113 cases (1.8%), inflammatory complications requiring antibiotics in 7/113 cases (6.2%), transient Grade I radiodermatitis in 6/113 patients (4.4%), and seroma which resolved spontaneously in 3/113 patients (2.7%). With median followup of 39 months (range 3.3-75.3) no relapses were observed. No late complications in Radiation Therapy Oncology Group Grade 3 or higher were documented. Cosmetic outcome in patients with followup > 2 years was excellent or good in 92%. CONCLUSION: Our preliminary results show that the perioperative multicatheter interstitial high-dose-rate brachytherapy for APBI in selected patients with early breast cancer is feasible. This treatment schedule reduces treatment duration, spares the patients of repeated anesthesia, and enables precise application of the afterloading tubes under direct visual control.
- MeSH
- brachyterapie škodlivé účinky metody MeSH
- celková dávka radioterapie MeSH
- katétry MeSH
- kombinovaná terapie škodlivé účinky metody MeSH
- lidé středního věku MeSH
- lidé MeSH
- lokální recidiva nádoru MeSH
- nádory prsu radioterapie chirurgie MeSH
- prsy patologie účinky záření chirurgie MeSH
- segmentální mastektomie škodlivé účinky metody MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- studie proveditelnosti MeSH
- výsledek terapie MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
Akcelerovaná parciální radioterapie karcinomu prsu (APBI) je metoda, která u vybraných pacientek s časným karcinomem nahrazuje po prs šetřících chirurgických výkonech ozáření celého prsu (WBI) ozářením oblasti lůžka tumoru s bezpečnostním lemem. Výhodou oproti WBI je zkrácení celkové doby léčby a menší objem ozářených zdravých tkání. Pro APBI byla použita řada technik: konformní zevní radioterapie (3D RT), radioterapie s modulovanou intenzitou (IMRT), intraoperační zevní radioterapie elektronovým svazkem, intrabeam, balónová brachyterapie a intersticiální brachyterapie. Nejzralejší data jsou k dispozici pro pooperační intersticiální multikatétrovou brachyterapii (MIB). Perioperační aplikace MIB dále zkracuje celkovou dobu léčby, šetří pacientky od opakované anestézie a umožňuje precizní zavedené brachyterapeutických katétrů pod přímou vizuální kontrolou. Podmínkou APBI je dodržení mezinárodních indikačních kritérií.
Accelerated partial breast irradiation (APBI) is a method substituting whole breast irradiation (WBI) in selected patients with early breast cancer after breast sparing surgery. The advantage in comparison with WBI is shortening of treatment duration and less volume of irradiated healthy tissues. Several techniques were used for APBI: conformal external beam radiotherapy (3D EBRT), intensity modulated radiotherapy (IMRT), intraoperative irradiation with electron beam, intrabeam, balloon brachytherapy, interstitial brachytherapy. The most mature data exist for postoperative multicatheter interstitial brachytherapy (MIB). Perioperative application of MIB reduces further the treatment duration, spares the patients of repeated anesthesia and enables precise application of brachytherapy catheters under direct visual control. The condition of APBI is adherence to international indication criteria.
- Publikační typ
- abstrakt z konference MeSH
Díky mamárnímu screeningu je dnes karcinom prsu zachycován ve stále časnějším stadiu. Z toho vyplývá, že i chirurgové jsou stále častěji postaveni před úkol řešit operačně tumory prsu, které jsou klinicky nehmatné. Při těchto operacích jsou odkázáni zcela na přesné označení lokalizace tumoru pomocí navigace (kovový vodič, pigmenty). Ve sdělení je popsán postup rutinně používaný na pracovišti autorů, je zde poukázáno na některá úskalí, která s sebou praxe přináší. Aby byly výsledky léčby co nejlepší, je nutná kvalitní spolupráce radiodiagnostika, chirurga (mamárního onkochirurga), klinického a radiačního onkologa, patologa a lékaře z oddělení nukleární medicíny. Tato úzká mezioborová spolupráce se zpětnou vazbou je nezbytnou podmínkou pro optimální výsledky léčby i u pacientů s časnými stadii maligních onemocnění prsu.
Breast cancer is nowadays captured still in earlier stages through screening mammography. Consequently, even surgeons are increasingly faced with the task to solve nonpalpable breast tumors surgically. Performed operations are dependent entirely on the precise identification of tumor localization with help of navigation (metal wire, pigments). The review describes the procedure routinely used by authors, it points out some difficulties, which occur in clinical practice. High quality cooperation between radiologist, surgeon (breast cancer surgeon), clinical and radiation oncologist, pathologist and physician of the department of nuclear medicine is needed for the best treatment results. This close interdisciplinary cooperation with feedback is necessary requirement for the optimal treatment outcomes in patients with early stages of malignant breast cancer.
- MeSH
- axila MeSH
- diferenciální diagnóza MeSH
- implantace prsní náhrady * škodlivé účinky MeSH
- lidé MeSH
- lymfatické nemoci * diagnóza etiologie MeSH
- nádory prsu diagnóza etiologie MeSH
- prsní implantáty škodlivé účinky MeSH
- silikony škodlivé účinky MeSH
- Check Tag
- lidé MeSH
- ženské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
