乳腺癌根治术后不同方法放疗长期疗效研究  

Research on the Long Term Efficacy of Different Irradiation Methods for Postoperative Breast Cancer

作　　者：郁志龙[1] 赵建国[1] 张保祯[1] 刘秀兰[1] 闫文明[1] 孙晓革[1] 林宇[1] 张剑[1] 杨昊[1] 祁真[1] 

机构地区：[1]内蒙古医学院附属医院放疗科,内蒙古呼和浩特010050

出　　处：《内蒙古医学杂志》2011年第12期1414-1417,共4页Inner Mongolia Medical Journal

摘　　要：目的:探索乳腺癌根治术后大分割放疗的远期疗效和副作用。方法:利用随机分组的方法,将578例乳腺癌根治术后患者分为常规分割放疗组(A组)、3 Gy分割组(B组)和大分割组(C组)3组进行放疗,并进行长期随访观察和随访资料分析。A组放疗方法为:2.0 Gy/次,1次/d,5次/w,总剂量50 Gy;B组为:3Gy/次,1次/d,5次/周,总剂量45 Gy;C组为:5 Gy第1、3 d,6.5 Gy/15、17 d,总剂量为23 Gy。结果:所有患者均完成了治疗,随访时间15～18年,中位随访时间16.4年,死亡170例,失访36例,随访率93%。死亡原因多为远处转移或局部复发并远处转移。9例患者死于心脏事件。治疗期间,A、B组123例有明显放射反应,表现为乏力、食欲不振、轻度恶心和不同程度的吞咽不适、梗阻或吞咽疼痛。C组除放疗当日和次日有轻度乏力、恶心外,其余无不良反应。A、B组疗中或疗后均有不同程度的皮肤色素沉着,部分有干性脱皮和湿性脱皮。C组仅有轻质皮肤发红和色素沉着改变,皮肤变化与A、B组差异有统计学意义(P<0.001)。1、2级放射性肺炎、肺纤维化和上肢水肿A、B组与C组间也存在差异有统计学意义(P<0.001),3级肺炎、胸壁纤维化、肋骨骨折和心脏事件等C组很低,差异具有统计学意义。各组死亡率、复发率和远处转移率均相似,差异没有显著性。结论:B、C两组放疗方法可获得与常规方法相似的效果,特别是C组方式,明显减轻了放疗反应,缩短了治疗时间。Objective：To explore the long term efficacy and toxicity of postoperative hypofractionated radiotherapy for breast cancer.Methods： 578 cases were divided into three groups according to different radiotherapy methods,conventional fractionation（group A） which gives 50 Gy with 2 Gy/per fraction,a fraction/day,five fractions/week;3 Gy fractionation（group B） which gives 45 Gy with 3 Gy/fraction,a fraction/day,five fractions/week;5 Gy fractionation（group C） which gives 23 Gy with 5 Gy/d1,3,6.5 Gy/d15,17.Results： All patients completed the therapy plan.The patients were followed up 15~18 years with median follow up was 16.4 years.170 cases died and 36 failured of follow-up survey with a follow-up rate of 93%.The main death reason was distant metastasic and local recurrence with 9 cardiac events.123 patients in A and B groups were observed obviously acute reaction,including weakness,inappetence,nausea,difficult or pain swallow.Patients in C group were observed mild acute reaction,only including weakness and nausea at the 1~2 days.Patients in A and B groups showed different degree pigmentation and some dry or wet dermatitis.However,patients in C group showed mild red and pigmentation with a significant difference between A,B groups（P0.001）.Compared： with A,B groups,C group was significant difference in Grde I-Ⅱ radiation pneumonitis,pulmonary fibrosis and upper extremity lymph edema（P0.001）.Grde Ⅲ pneumonitis,chest wall fibrosis,rib fractu and heart event were graet lower than A,B groups and showed significant difference.The mortality,recurrence and the distant metastasis rate were similar in every group,and no significant difference.Conclusions B and C groups showed a similar efficacy to A group.However,C group obviously alleviated the side-reaction and shortened the treatment time.

关 键 词：乳腺癌 根治术 放射疗法 大分割放疗 

分 类 号：R815.16[医药卫生—放射医学]