早期乳腺癌保乳术后三维适形加速部分乳腺照射的疗效  

Clinical effects of accelerated partial breast irradiation using three-dimensional conformalradiotherapy in patients with early breast cancer after breast-conserving therapy

作　　者：蔡钢[1] 梅欣[1] 胡伟刚[1] 陈兰飞[1] 谢耩[1] 俞晓立[1] 杨昭志[1] 潘自强[1] 郭小毛[1] 陈佳艺[1] 

机构地区：[1]复旦大学上海医学院肿瘤学系复旦大学附属肿瘤医院放疗科,上海200032

出　　处：《中华放射肿瘤学杂志》2013年第2期94-98,共5页Chinese Journal of Radiation Oncology

基　　金：国家自然科学基金面上项目（81172504）;上海市科学技术委员会自然基金（10ZRl406700）

摘　　要：目的分析早期低危乳腺癌保乳术后三维适形加速部分乳腺照射（APBI）的局部控制情况、美容评价及不良反应，并对剂量学结果进行质量评估。方法2008--2010年前瞻性临床Ⅱ期研究入组39例早期（0～I期）乳腺癌保乳术后患者，其中浸润性导管癌28例、导管原位癌5例、其他类型浸润性癌6例。放疗处方剂量为38．5Gy分10次，2次／d，问隔6h以上。不良反应评价采用NCI-CTC3．0标准，美容评价依据Harris美容级别标准。结果三维适形APBI技术应用于早期乳腺癌保乳术后获得了满意的剂量学结果，85％（33例）患者完全满足放疗质量控制评估标准。与ASTRO、GEC-ESTRO共识比较中危／高危患者比例分别为46％、18％和31％、3％。随访率100％，无一局部复发，无3、4级不良反应。放疗后6个月美容评价优异加良好者占90％（35例）。结论三维适形APBI人组患者选择恰当，局部控制、不良反应和美容评价初步结果较好。Objective To assess the clinical effects of accelerated partial breast irradiation （APBI） using three-dimensional conformal radiotherapy （3DCRT） in patients with low-risk early breast cancer after breast-conserving therapy （BCT） with respect to dosimetric parameters, local control, toxicities, and cosmetic outcome. Methods Thirty-nine patients with early breast cancer （ stage 0--1 ） were enrolled in a prospective phase Ⅱ trial of APBI using 3DCRT in 2008--2010. Of all the patients, 28 had invasive ductal carcinoma, 5 had ductal carcinoma in situ, and 6 had other types of invasive carcinoma. The prescribed dose was 38.5 Gy/10 fractions twice daily, with an inter-fraction interval greater than 6 h. The toxicities were assessed according to the National Cancer Institute Common Toxicity Criteria, version 3. O. The cosmetic outcome was assessed according to the Harris breast cosmesis scale. Results The planning target volume coverage and normal-tissue dosimetry were appropriate in the APBI using 3DCRT. Dose homogeneity without deviation was achieved in 33 patients （85%）. Of the total 39 patients, 46% met ASTRO＇ s “cautionary” criteria, and 18% met“unsuitable”criteria;also, 31% met GEC-ESTRO＇s“intermediate-risk”criteria, and 3% met“ high-risk” criteria. The follow-up rate was 100%. No patient experienced local recurrence, and no grade 3---4 toxicities were found. Cosmesis was good to excellent in 35 patients （90%） at 6 months after APBI. Conclusions The patients with early breast cancer after BCT are properly selected for APBI using 3DCRT, with satisfactory preliminary assessment results for local control, toxicities, and cosmetic outcome.

关 键 词：乳腺肿瘤 三维适形放射疗法 加速部分乳腺照射 乳腺肿瘤 外科学 乳房切 除术 区段 治疗结果 

分 类 号：R737.9[医药卫生—肿瘤]