早期乳腺癌保乳术后行全乳大分割同步瘤床加量放疗的临床分析  

Clinical analysis of the effect of whole breast hypofractionated radiotherapy with simultaneous integrated boost for early breast cancer patients after breast-conserving surgery

作　　者：魏南 叶明[1] 谢华英[1] WEI Nan;YE Ming;XIE Huaying(Department of Radiotherapy,Renji Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200127,China;Department of Radiotherapy,Anhui No.2 Provincial People’s Hospital,Hefei 230000,Anhui Province,China)

机构地区：[1]上海交通大学医学院附属仁济医院放射诊疗科,上海200127 [2]安徽省第二人民医院放射治疗科,安徽合肥230000

出　　处：《肿瘤》2022年第8期552-561,共10页Tumor

摘　　要：目的:早期乳腺癌患者保乳术后行全乳大分割同步瘤床加量放疗(hypofractionated radiotherapy with simultaneous integrated boost,HFRT-SIB)与常规分割放疗(conventional fractionated radiotherapy,CFRT)2种放疗方案间的临床治疗效果及安全性比较。方法:选取2016年1月—2018年12月上海交通大学医学院附属仁济医院收治的230例早期(pT1-2N0M0)乳腺癌保乳术后进行辅助放疗的患者进行回顾性分析。其中,行全乳HFRT-SIB的患者(HFRT-SIB组)共116例,行全乳CFRT的患者(CFRT组)共114例;CFRT组中接受常规分割序贯加量放疗的患者共89例,接受常规分割同步加量放疗的患者共25例。2组均应用调强适形放射治疗(intensity-modulated radiation therapy,IMRT)技术进行治疗。HFRT-SIB组患者全乳照射计划靶体积(planning targetvolume,PTV)放疗剂量为39.9Gy/15Fx,单次放疗剂量为2.66Gy,瘤床PTV总放疗剂量为49.95Gy/15Fx,单次放疗剂量为3.33Gy,总治疗时间为3周;CFRT组患者放疗剂量为50 Gy/25 Fx,单次放疗剂量为2 Gy,瘤床序贯或同步加量至60 Gy,总治疗时间为5~6周。根据患者的定期随访病历记录和电话随访记录比较2组患者间的局部控制率、皮肤毒副反应及美容效果。结果:HFRT-SIB组中有2例患者发生局部区域转移,局部控制率为98.3%;CFRT组中有3例患者发生局部区域转移,局部控制率97.8%,2组间差异无统计学意义(P>0.05)。HFRT-SIB组中3级急性放射性皮炎的发生率为10.3%,而CFRT组中3级急性放射性皮炎的发生率为21.1%,HFRT-SIB组中的3级急性放射性皮肤损伤发生率明显低于CFRT组,差异有统计学意义(P<0.05)。放疗前HFRT-SIB组美容效果优良率为90.5%,CFRT组美容效果优良率为89.5%,差异无统计学意义(P>0.05);放疗后HFRT-SIB组美容效果优良率为85.3%,CFRT组美容效果优良率为84.2%,差异无统计学意义(P>0.05),每组患者放疗前后美容效果优良率的差异亦均无统计学意义(P>0.05)。结论:早期乳腺�Objective:To compare the clinical efficacy and safety of whole breast hypofractionated radiotherapy with simultaneous integrated boost(HFRT-SIB)and whole breast conventional fractionated radiotherapy(CFRT)for early breast cancer patients after breast-conserving surgery.Methods:A retrospective analysis was performed on 230 patients with early breast cancer(pT1-2N0M0),all of whom have accepted adjuvant radiotherapy after breast-conserving surgery in Shanghai Jiao Tong University School of Medicine Affiliated Renji Hospital from January 2016 to December 2018,including 116 cases receiving whole breast HFRT-SIB(HFRT-SIB group)and 114 cases receiving whole breast CFRT(CFRT group).In the CFRT group,89 cases received sequential boost to the tumor bed,and 25 cases received simultaneous integrated boost(SIB).Intensity-modulated radiation therapy(IMRT)was used in both groups.The radiation dosage for patients in the HFRT-SIB group was 39.9 Gy in 15 fractions in the whole breast planning target volume(PTV)with tumor bed boost to 49.95 Gy in 15 fractions in the course of 3 weeks.The radiation dosage for patients in the CFRT group was 50 Gy in 25 fractions to the whole breast with the tumor bed boost to 60 Gy in 25 or 30 fractions in a course of 5-6 weeks.The local control rate,skin toxicity and cosmetic outcomes were evaluated and compared between the two groups according to the medical records of the patients with regular follow-up and telephone follow-up.Results:The HFRT-SIB group had a local control rate of 98.3%with local regional metastasis occurred in 2 patients.The CFRT group showed a local control rate of 97.8%with local regional metastasis occurred in 3 patients.No statistical difference in local control rate was found between the two groups(P>0.05).The incidence of grade 3 acute radioactive dermatitis in the HFRT-SIB group was 10.3%while that in the CFRT group was 21.1%.The incidence of grade 3 acute radioactive dermatitis in the HFRT-SIB group was significantly lower than that in the CFRT group(P<0.05).Before radiot

关 键 词：早期乳腺癌 保乳术 全乳放疗 大分割放疗 同步瘤床加量 

分 类 号：R737.9[医药卫生—肿瘤]