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Unresectable bulky chest wall recurrent breast cancer controlled with CT-guided interstitial high-dose-rate brachytherapy and external beam radiotherapy with adjuvant hormonal therapy – case report
Journal of Contemporary Brachytherapy ( IF 1.4 ) Pub Date : 2021-08-24 , DOI: 10.5114/jcb.2021.108600
Hiroaki Kunogi 1 , I-Chow Hsu 2 , Keisuke Sasai 1
Affiliation  

Introduction
Bulky chest wall recurrence after mastectomy presents a therapeutic challenge because of high-dose of radiation required to control the disease, and its proximity to low-tolerance organs at risk. We report a case of successful computed tomography (CT)-guided high-dose-rate (HDR) salvage interstitial brachytherapy (ISBT) boost.

Material and methods
A 70-year-old female initially presented with a tumor in right breast, and was treated with mastectomy and adjuvant chemotherapy, followed by hormonal therapy for 5 years without adjuvant radiotherapy. In 2018, 20 years after the initial treatment, she developed unresectable chest wall recurrence that measured 10.5 cm × 7.3 cm × 4.5 cm, with bone and parietal pleura invasion. Biopsy revealed invasive pleomorphic lobular carcinoma [estrogen receptor (ER)-positive, progesterone receptor (PR)-negative, HER2-negative]. There was no evidence of metastatic disease.

Results
The patient underwent external beam radiotherapy (EBRT) plus ISBT. After EBRT of 50 Gy in 25 fractions was completed, CT-guided ISBT was performed as an outpatient treatment. HDR dose was 16 Gy delivered in 2 fractions with 2 implants. Dose was prescribed to gross tumor volume. ISBT plans were created using inverse planning simulated annealing (IPSA) algorithm. Gross tumor volume D90% plus EBRT dose was 82 Gy equivalent dose of 2 Gy (EQD2), assuming α/β of 4 for breast carcinoma. The patient continued on hormonal therapy. At the 30-month follow-up, the patient remains in remission. The tumor could not be detected by magnetic resonance imaging (MRI) or positron emission tomography (PET). There were no severe treatment-related complications.

Conclusions
CT-guided HDR ISBT boost can be a useful modality in individualizing treatment strategies for breast cancer patients with unresectable bulky chest wall recurrence.



中文翻译:

CT引导的间质高剂量率近距离放射治疗和辅助激素治疗的外束放射治疗控制不可切除的大胸壁复发性乳腺癌 - 病例报告

简介
乳房切除术后大块胸壁复发对治疗提出了挑战,因为控制疾病需要高剂量的辐射,并且它靠近处于危险中的低耐受性器官。我们报告了一例成功的计算机断层扫描 (CT) 引导的高剂量率 (HDR) 抢救间质近距离放射治疗 (ISBT) 增强病例。

材料与方法
一名 70 岁女性最初出现右乳肿瘤,接受乳房切除术和辅助化疗,随后激素治疗 5 年,未进行辅助放疗。2018 年,在初次治疗 20 年后,她出现了无法切除的胸壁复发,大小为 10.5 cm × 7.3 cm × 4.5 cm,侵犯骨和壁层胸膜。活检显示侵袭性多形性小叶癌[雌激素受体 (ER) 阳性,孕激素受体 (PR) 阴性,HER2 阴性]。没有转移性疾病的证据。

结果
患者接受了外照射放疗(EBRT)加 ISBT。完成 25 次 50 Gy 的 EBRT 后,进行 CT 引导的 ISBT 作为门诊治疗。HDR 剂量为 16 Gy,分 2 次使用 2 个植入物。根据总肿瘤体积规定剂量。ISBT 计划是使用逆向计划模拟退火 (IPSA) 算法创建的。假设乳腺癌的 α/β 为 4,总肿瘤体积 D90% 加上 EBRT 剂量为 82 Gy 等效剂量 2 Gy (EQD2)。患者继续激素治疗。在 30 个月的随访中,患者仍处于缓解期。通过磁共振成像(MRI)或正电子发射断层扫描(PET)无法检测到肿瘤。没有严重的治疗相关并发症。

结论
CT 引导的 HDR ISBT 增强对于无法切除的大块胸壁复发的乳腺癌患者的个体化治疗策略可能是一种有用的方式。

更新日期:2021-08-27
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