早期乳腺癌保乳术后大分割三维放疗Ⅱ期临床观察  

Phase Ⅱ clinical trial of central hypofractionated three-dimensional radiotherapy for patients with early-stage breast cancer after breast-conserving surgery

作　　者：邓垒[1] 惠周光[1] 王淑莲[1] 陈波[1] 唐玉[1] 余子豪[1] 刘新帆[1] 金晶[1] 王维虎[1] 宋永文[1] 刘跃平[1] 任骅[1] 戴建荣[1] 李晔雄[1] 

机构地区：[1]北京协和医学院中国医学科学院肿瘤医院肿瘤研究所放疗科,100021

出　　处：《中华放射肿瘤学杂志》2013年第1期1-4,共4页Chinese Journal of Radiation Oncology

基　　金：卫生部临床学科重点项目（136）;北京市科技新星计划（B类）（2008B80）;北京希望马拉松专项基金（LC2008B37）

摘　　要：目的 观察早期乳腺癌保乳术后大分割三维放疗的疗效、美容效果和不良反应。方法 2009—2010年45例pT is-2N 0-1M 0期乳腺癌患者保乳术后行三维适形或简化调强放疗,全乳43.5 Gy,瘤床补量8.7Gy,2.9Gy/次, 总疗程24 d。33例接受了化疗,其中新辅助化疗2例、术后化疗31例。局部区域控制率和总生存率用Kaplan Meier法计算。结果 随访率100%。2年局部区域控制率、生存率均为100%;1例单发骨转移。2级乳房水肿1例,2级乳房纤维化6例,2级上肢水肿1例。2级放射性皮炎4例,1、2级放射性肺炎分别为5、2例。与同期保乳术后常规分割放疗相比,放疗次数由30次降至18次,疗程由40 d缩短至24 d,费用由30450元降至19770元。结论 乳腺癌保乳术后全乳大分割放疗的疗效和美容效果较好,不良反应可接受,且能显著降低治疗时间和费用。Objective To observe the therapeutic effects, cosmetic results, and toxicities of central hypofractionated three-dimensional radiotherapy for patients with early-stage breast cancer after breast-conserving surgery. Methods From February 2009 to February 2010, 45 patients with pT is-2 N 0-1 M 0 breast cancer after breast-conserving surgery were enrolled in the trial. Three-dimensional conformal radiotherapy or simplified intensity-modulated radiotherapy was applied to each patient. The hypofractionated radiotherapy schedule was 43.5 Gy/15 fractions/3 weeks to the whole breast, with a boost of 8.7 Gy/3 fractions/3 days to the tumor bed. The dose was 2.9 Gy per fraction;the total course of treatment was 24 days. Thirty-three patients received chemotherapy, including neoadjuvant chemotherapy in 2 patients and postoperative adjuvant chemotherapy in 31 patients. Locoregional control and overall survival were calculated by Kaplan-Meier method. Results The follow-up rate was 100%. The 2-year locoregional control and overall survival were both 100%, and one patient had a single bone metastasis. Of the patients, 1 developed grade 2 breast edema, 6 developed grade 2 breast fibrosis, 1 developed grade 2 upper extremity edema, 4 developed grade 2 radiation dermatitis, 5 developed grade 1 radiation pneumonitis, and 2 developed grade 2 radiation pneumonitis. Compared with the conventional fractionated radiotherapy for the patients with early-stage breast cancer after breast-conserving surgery, the hypofractionated three-dimensional radiotherapy had the number of fractions decreased from 30 to 18, courseof treatment shortened from 40 days to 24 days, and the cost cut from ￥30450 to ￥19770. Conclusions The central hypofractionated three-dimensional radiotherapy for the patients with early-stage breast cancer after breast-conserving surgery have good therapeutic effects and cosmetic results and acceptable toxicities, as well as significantly reduced time and cost of treatment.

关 键 词：乳腺肿瘤 外科学 外科学 保乳术 乳腺肿瘤 放射疗法 放射疗法 大分割放疗 治疗结果 

分 类 号：R737.9[医药卫生—肿瘤]