| First Part: The safety and efficacy of implanted 125 I radioactive particles for the treatment of recurrent breast cancerObjective: To retrospectively evaluate the efficacy and safety of ultrasound or CT guided implantation of 125 I particles for recurrent breast cancer,and provide basis for the clinical application of 125 I seeds implantation in recurrent breast cancer.Methods: Between January 2009 to December 2016,38 cases of recurrent breast cancer patients(female;Age 41-92,the average age of 49 years old;Number of lesions was 2.8 on average,range of 1-7)received ultrasound or CT guided brachytherapy.The lesions can't be excised,after conventional chemotherapy and/or endocrine therapy can't effectively control,external exposure assessment can't tolerance treatment.The treatment planning was draw up by the treatment planning system(TPS)before implantation,include the number of 125 I particles,spatial distribution and the dose distribution.The activity of 125 I seed was 0.58 m Ci,set prescription doses of 90-110 Gy,plans to target matching dose(MPD)is 85-120 Gy.CT-based evaluation after 1,3 and 6months,and follow-up to evaluate curative effect,local control,survival rate,and postoperative complications.Results: all patients were successfully implanted 125 I particles as planned,no operation related deaths occurred,the number of implanted 125 I particles was10-52 grain,with an average of 23.Of 38 patients evaluated,18 cases with local pain was pain relief,rate of pain relief was 100%(P < 0.05).Karnofsky score increased significantly(P < 0.05).After 6 months,10 cases were complete response(CR),24 were partial response(PR),2 were stability(SD),2 were progress(PD).The total effective rate(CR + PR)was 89.4%,tumor control rates(CR + PR + SD)was 94.7%.1,3,6 months total effective rate were 47.4%,86.8%,89.4%,tumor control rates were 100%,100% and 94.7% respectively.Postoperative follow-up of 12 to 60 months,the median time was 36 months,1,3,5 years local control(CR + PR + SD)were 78.9%,47.4% and 5.3%.Subgroup analysis showed that effectiveness between different pathological types and local control rates found no significant difference.The 1,3,5 years survival rate were 94.7%,65.8% and 26.3% respectively.All patients were not found serious adverse events associated with implantation of 125 I particles,only five patients had mild skin reactions.Conclusion: The 125 I seeds implantation for treatment of recurrent breast cancer is safe and effectivet,with efficient tumor local control and good analgesic effect,can improve the quality of life,has great value in clinical application.Second Part: Combination of 125 I brachytherapy and comprehensive therapy for recurrent breast cancerObjective: To explore the feasibility and efficacy of the combination of 125 I brachytherapy and chemotherapy/endocrine therapy for the treatment of unresectable recurrent breast cancer,and provide basis for the clinical application of combination of 125 I brachytherapy and comprehensive therapy for recurrent breast cancer.Methods: Between January 2009 to December 2016,57 cases of recurrent breast cancer patients received ultrasound or CT guided brachytherapy.After implantation,all systematic treatment such as chemotherapy or endocrine therapy were used in combination,as observation group.Included another 57 cases of recurrent or metastatic breast cancer patients in the same period as control group,two groups of patients with major clinical factors comparable.Two groups of patients were female,patients in observation group aged 38-69,with an average of 47 years.Number of lesions was 2.8 on average,range of 2-8;25 cases of tumor diameter < 3 cm,3-5 cm in 16 cases,> 5 cm in 16 cases,the average diameter was 3.6 cm.Patients in control group aged 40 to 64 years old,with an average age of 46.Number of lesions was 3.3,range is 2 to 10;23 cases of tumor diameter < 3 cm,3-5cm in 19 cases,> 5 cm in 15 cases,the average diameter was 3.4 cm.The treatment planning was draw up by the treatment planning system(TPS)before implantation,include the number of 125 I particles,spatial distribution and the dose distribution.The activity of 125 I seed was0.58 m Ci,set prescription doses of 90-110 Gy,plans to target matching dose(MPD)is 85-120 Gy.Postoperative treatment according to the conventional treatment scheme selection of chemotherapy,endocrine therapy or targeted therapy.Another selection in comparable 57 cases of recurrent breast cancer patients as control group,according to the conventional scheme to chemotherapy,endocrine therapy or targeted therapy.CT-based evaluation after 1,3 and 6months,and follow-up to evaluate curative effect,local control,survival rate,and postoperative complications.Results: In observation group,all of the patients were successfully implanted125 I particles as planned,no operation related deaths occurred,implanted 125 I particle number 20-100,with an average of 32.After treatment,the rate of pain relief was 100% in observation group and 74.3% in control group(P < 0.05).Karnofsky score significantly improved in both groups(P < 0.05).6 months after treatment,in observation group,total effective rate was 80.7%,local control rate was 100%;in control group,total effective rate was 54.4%,local control rate was 94.7%.The effective rate in observation group was obviously higher than that of control group(P < 0.05).Follow-up was performed for 8 to 60 months after treatment,the median time was 36 months.In observation group,6,12,36 months progression-free survival(PFS)was 96.5%,64.9% and 96.5%respectively;1,3,5 year overall survival(OS)were 91.2%,50.8% and 26.3%,respectively.In control group,6,12,36 months progression-free survival(PFS)was 85.9%,45.6% and 85.9% respectively;1,3,5 year overall survival(PFS)was 80.7%,80.7% and 35.1% respectively.Survival analysis showed that The combination of 125 I brachytherapy and comprehensive therapy resulted in a statistically significant improvement in PFS and OS(P < 0.05).There were a few toxicity and complications,and no patients died during the perioperative period.The incidence of side effects was comparable between treatment arms,and these complications were related to chemotherapy,no obvious side radiotherapeutic effect was observed.Conclusion: 125 I radioactive particles combined chemotherapy,endocrine therapy or targeted therapy is superior to the treatment of chemotherapy,endocrine or targeted therapy alone,125 I radioactive particles implantation combined comprehensive therapy for recurrent metastatic breast cancer is safe and effective,is a kind of new treatment strategy,and worthy of further research and proper application in clinical practice.Third Part: The study on dosimetric verification of 125 I radioactive particles implantation in recurrent breast cancerObjective: To research the dosimetric difference between the preimplantation plan and the postimplantation plan and to explore the actual effect of the difference to efficacy,compare the difference of dose distribution after implantation of radioactive particles guided by ultrasound or CT.Methods: Between January 2009 to December 2016,95 paitients with unresectable recurrence breast cancer patients were treated with lasl seeds implantation under the guidance of B-ultrasonography or CT.All patients were female,aged 38-92,with an average age of 48.All patients underwent CT and ultrasound examination before implantation,with histologically confirmed locally advanced or metastatic disease,and lesions were inoperable;prior surgery,chemotherapy and radiation were performed,hormone therapy or targeted therapy were allowed.The pre-plan was accomplished according to the TPS to reconstruct tumor three-dimensional image and to calculate the seed number,placement and dose distribution.The activity of 125 I seed was 0.58 m Ci,set prescription doses of 90-110 Gy,plans to target matching dose(MPD)is85-120 Gy.dosimetric verification was accomplished in one week after implantation.The difference of D80,D90?D100?V90?V100(the percentage of the PTV volume receiving 100% of the prescription dose)? V150 ?m PD(minimum peripheral dose),Dmean(mean absorbed dose)? PTV volume between preimplantation and postimplantation were compared.All the patients were evaluated with CT examinations 1,3,6 months after the treatment.The pain relief time,efficacy,the local control rate and complications after operation were observed.Results: There were no difference in D80?D90?V150?Dmean?PTV volume between preplan and postplan(P>0.05),but were difference in D100 ? V90 ?V100(P<0.05).CT or ultrasound two guide ways there was no significant difference in postoperative dosimetry parameters.6 months after treatment,complete remission(CR),partial remission(PR),stable disease(SD),and progress disease(PD)were seen in 28(29.5%),52(54.7%),13(13.7%),and 2(2.1%)patients respectively,the total effective rate(CR + PR)was 84.2%,the local control rate(CR + PR+ SD)was 97.9%.All patients were not found serious adverse reactions associated with implantation of 125 I particles.Conclusion: After the implantation of 125 I particles,dosimetric verification is the gold standard to determine the actual dose of the tumor.Expected dosimetric distribution can be achieved basically according to dosimetric verification of 125 I particles implantation,it can control the tumor effectively;125I implanted guided by B ultrasound or CT can achieve the desired dose distribution. |
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