乳腺癌保乳术后锁上预防照射与上肢水肿发生的关系  

Association between supraclavicular irradiation and lymphedema in breast cancer patients with conservative surgery

作　　者：姚波[1] 郑明民[1] 高军茂[1] 

机构地区：[1]北京军区总医院放疗科,北京100700

出　　处：《癌症进展》2012年第3期271-274,250,共5页Oncology Progress

摘　　要：目的分析乳腺癌保乳术后放疗后,上肢淋巴水肿发生率与锁上预防照射的关系及其他相关因素的分析。方法回顾分析81例保乳术后乳腺癌患者,均采用三维适形(3DCRT)或调强放射治疗(IMRT)技术。锁上放疗25例(30.9%),腋窝淋巴结未清扫5例,前哨活检6例,其余70例均为全腋窝清扫术。术后单纯放疗16例,放疗化疗综合治疗65例。上肢淋巴水肿评估采用电话问卷方法,患者自行比较两侧上肢,根据差异程度记作1～3分。结果中位随访时间38.7个月。全部患者上肢水肿发生率24.7%,其中1分12例(60%),2分6例(30%),3分2例(10%)。锁上放疗者较未放疗者上肢水肿发生率高,分别为40%和19.7%,P=0.033。5例腋窝淋巴结未清扫者无1例上肢水肿,腋窝前哨活检有2例(25%)上肢水肿,但与清扫术相比差异均未达到统计学意义。体重≥65kg者有增加水肿发生率趋势,P=0.094。其他因素,年龄、淋巴结清扫数目、体重指数(BMI)、放疗技术、内分泌治疗和是否化疗均未增加上肢水肿发生率。结论采用3DCRT或IMRT放疗的保乳术后乳腺癌,锁上放疗增加了上肢淋巴水肿发生率,腋窝淋巴结清扫、体重也有增加水肿的趋势。Objective To examine the assneiation between the ineidence of lymphedema anti supraclavieular irradia- tion after radiotherapy in breast canc, er patients with conservative surgery. Methods A total of 81 breast caneer patients who were retrospectively analyzed underwent conservative surgery followed by three-dimensional conformal radiotherapy （3DCRT） or intensity-modulated radiotherapy （IMRT）. SupracLavieular irradiation was recommended in 25 patients （30. 9% ）. 5 patients did not receive full axillary lymph node dissection （ALND） and 6 experienced sentinel node dissection （SLND）. The remainder received ALND. 16 patients received postoperative radiotherapy ＇alone and 65 combined with chemo- therapy. A telephone questionnaire was used to assess arm lymphedema. The respondents were asked whether their right and left arms seemed to differ in size, anti they were to score the degree of lymphedema as 1 to 3. Results The median follow- up was 38.7 months. The overall incidence of lymphedema was 24. 7%. Of the patients with lymphedema, 12 eases （60%） scored 1 , 6 eases （30%） scored 2, and 2 cases scored 3. The rates of lymphedema in patients received and not received su- praclavieular irradiation were 40% and 19.7% , respectively, P =0. 033. None of the five patients without ALND and 2 with SLNI） developed lymphedema. But the differences did not appear statistieal significance. The patients weighed more than 65 kg were prone to lymphedema, P =0. 094. The other factors, age, the number of ALND, the body mass index （ BMI）, the technology of radiotherapy, chemotherapy, or endocrine therapy were not associated with the occurrence of arm lymphcdema. Conclusion Supraclavicular irradiation increased the incidence of arm lymphedema in the conservative breast cancer patients treated with 3DCRT or IMRT. ALND and body weight trended to increase lymphedema incidence.

关 键 词：淋巴水肿 乳腺癌 保乳术 放疗 

分 类 号：R737.9[医药卫生—肿瘤]