Zeynep ÖZSARAN, Yavuz ANACAK, Serra Arun KAMER, Umar NİANG, DENİZ YALMAN, Mustafa ESASSOLAK, Arif ARAS, Ayfer HAYDAROĞLU

Meme koruyucu cerrahi sonrası yüksek lokal yineleme riski bulunan meme kanserlerinde HDR brakiterapi boostu: 27 olgunun değerlendirilmesi

Meme koruyucu cerrahi ile tedavi edilen meme kanserli olgularda tümör boyutunun büyük olması veya cerrahi sınırda tümör varlığının lokal yineleme riskini arttırdığı ve bu olgularda riskin tümör yatağına daha yüksek radyoterapi dozları verilerek azaltılabileceği düşüncesi He Kasım 1993-Aralık 1996 tarihleri arasında meme koruyucu cerrahi uygulanmış meme kanserli 27 olguda 50 Gy eksternal radyoterapiyi takiben tümör yatağına 15-20 Gy interstisiel HDR brakiterapi boostu uygulanmıştır. T1 ve T2 olguların cerrahi sınırın çok yakın (< 1 cm) veya tutulmuş, T3 olguların ise tümör boyutu büyüklüğü nedeni He tedavi edildiği bu çalışmaya alınan 10 olguda T1, 13 olguda T2 ve 4 olguda T3 tümör saptanmıştır. Başlangıç T evresi T3 olan 13 olgu ve T2 olan 2 olgu 3-4 kür neoadjuvan kemoterapi He tümör küçüldükten sonra öpere edilmiştir. T3 tümörlü 2 olguda ise kemoterapi sonrası cerrahi uygulanmamıştır. Cerrahi sınır 13 olguda tutulmuş veya yakın olarak saptanmıştır. Eksternal radyoterapiden 1 hafta sonra brakiterapi planlanan olgulara çift planda, 7-13 iğne ile implantasyon yapılmış ve microSelectron-HDR cihazı He 3 günde 4-6 fraksiyonda toplam 15-20 Gy verilmiştir. Implantasyon ve tedavi sırasında önemli bir komplikasyon saptanmamış, brakiterapinin meme kozmetiğine olumsuz bir katkısı belirlenmemiştir. Radyoterapinin başlangıcından itibaren medyan takip süresinin 34 ay (aralık 3-93) olduğu çalışmada 4 olguda lokal yineleme, 4 olguda uzak metastaz saptanmış, 5 olgu hastalık yinelemesi nedeni He kaybedilmiştir. Beş yıllık genel sağkalım %81, hastalıksız sağkalım %69.7 ve lokal nükssüz sağkalım %87 olarak bulunmuştur.

Anahtar Kelimeler:

Mastektomi, segmental, Brakiterapi, Meme neoplazmları, Neoplazm metastazı, Neoplazm nüksü, lokal, Sağkalım analizi

HDR brachytherapy boost after breast conserving surgery in patients with a high risk of local recurrence evaluation of 27 cases

Local recurrence rate after breast conserving surgery increases with large tumor size or positive surgical margins. In such cases higher radiotherapy doses to the tumor bed is mandatory. Between November 1993 and December 1996, 27 patients received 15-20 Gy- interstitial HDR brachytherapy boost to the tumor bed following 50 Gy external radiotherapy after breast conserving surgery. Brachytherapy boost was applied because of close (<1 cm) or positive margins in T1 and T2 tumors and because of tumor size in T3 tumors. Ten patients had T1, 13 patients had 72 and 4 patients had T3 tumor. Initial T stage was T3 in 13 patients and 72 in 2 patients. These patients were given 3 or 4 cycles of preoperative chemotherapy and were operated after downstaging of the tumor. In 13 patients surgical marginswere close or positive. Interstitial brachytherapy was applied one week after the completion of external radiotherapy. Seven to 13 needles in a double plane were implanted. A total dose of 15-20 Gy in 4-6 fractions were applied in 3 days via microSelectron HDR remote afterloader. No complication was observed during or after implantation. Brachytherapy had no negative impact on breast cosmesis. Median follow-up duration was 34 months starting from the initiation of external radiotherapy. Four patients developed local recurrence and 4 developed distant metastasis. Five patients died due to recurrent or metastatic disease. Five-year overall, disease-free and local recurrens-free survival rates were 81%, 69.7% and 87% respectively.

Keywords:

Mastectomy, Segmental, Brachytherapy, Breast Neoplasms, Neoplasm Metastasis, Neoplasm Recurrence, Local, Survival Analysis,

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