乳腺癌保留乳房术后大分割调强放疗初步临床观察  

Preliminary clinical observation on patients with early-stage breast cancer after breast-conserving surgery treated with hypo-fractionated intensity-modulated radiotherapy

作　　者：郝福荣[1] 吕春燕[2] 刘杰[1] 姜迎宵[1] 马瑞忠[1] 王明臣[1] 

机构地区：[1]潍坊市人民医院放疗科,山东潍坊261041 [2]滕州市工人医院肿瘤科,山东滕州277500

出　　处：《中华肿瘤防治杂志》2013年第24期1912-1916,共5页Chinese Journal of Cancer Prevention and Treatment

基　　金：山东省自然科学基金(ZR2009CM081)

摘　　要：目的：观察早期乳腺癌保留乳房术后三维适形放疗（three-dimensional conformal radiotherapy，3-DCRT）、常规分割调强放疗（intensity-modulated radiotherapy，IMRT）及大分割调强放疗（hypo-fractionated intensity-modulated radiotherapy，hIMRT）的疗效、不良反应及美容效果。方法：选择2009～02—01—2013-01—31潍坊市人民医院放疗科早期乳腺癌保留乳房术后女性患者66例，根据患者意愿分别纳入3-DCRT、IMRT或kIMRT组行放疗。3DCRT组采用6Mv_X射线切线野照射，全乳腺Dr50Gy／25次，2Gy／次，后续9／12MeV电子线予瘤床区补量10Gy／5次，2Gy／次；IMRT组：采用逆向动态调强技术，以切线野方向为调强主野的入射方向，全乳腺50Gy／25次，2Gy／次，瘤床区用X射线同步加量至60Gy／25次，2．4Gy／次，或全乳腺放疗结束后行电子线补量（方式及剂量同3DCRT）；h-IMRT组：全乳腺42．5Gy／16次，2．66Gy／次，瘤床区同步X射线加量至48Gy。结果：3-DCRT组、IMRT组、h_IMRT组分别入组46、12和8例，中位随访23．9个月（2．1～48．0个月），3组患者免疫组化结果、病理类型、TNM分期、放化疗顺序及化疗方案、年龄、手术与术后’放疗时间间隔、肿瘤最大径和腋窝淋巴结转移数目差异均无统计学意义，P〉0．05；3组放疗时间差异有统计学意义，P〈O．01，其中h-IMRT组周期最短。单变量一般线性模型三因素方差分析显示，放疗前后乳头纵向、横向位置，乳房横径，乳根位置差异均无统计学意义，P〉O．05；保留乳房术后患者健侧乳头比患侧低，P〈0．05；3组间乳头横向位置和乳房横径差异有统计学意义，P〈O．05。3组患者均发生不同程度的急性血液系统和皮肤反应，但差异无统计学意义，P〉0．05，无Ⅲ度及更严重的急性放射性皮肤反应，均未影响放疗计划的顺利进行。结论：短期随访结果显示，早期乳腺癌保留�OBJECTIVE：To observe differences of short-term efficiency,cosmetic outcome and adverse-events of pa- tients with early-stage breast cancer after breast-conserving surgery treated with three-dimensional eonformal radiotherapy （3-DCRT）, conventional fraetioned Intensity-modulated radiotherapy （IMRT） or hypo-fractionated Intensity modulated radiotherapy （h-IMRT） respectively. METHODS： From 1 February 2009 to 31 January 2013 Weifang People＇s Hospital, 66 women cases with early-stage breast cancer after breast-conserving were enrolled in 3-DCRT group, IMRT group, and h-IMRT group respectively according to the patient＇s attention. In 3-DCRT,the whole breast was irradiated 50 Gy in 25 fractions over 35 days using 6 megavolt photons by tangential fields conformal technology, then 9 or 12 MeV electronbeam boost was done to a dose of 10 Gy in 5 fractions over one week. In IMRT group,using photon inverse dynamic inten- sity-modulated radiation therapy,and incorporated photon beam boost or followed 9 or 12 MeV electron beam boost, the whole breast received 50 Gy and the lumpectomy bed 60 Gy in 25 treatments over 5 weeks. In h IMRT group,using pho- ton inverse dynamic intensity-modulated radiation therapy and incorporated photon beam boost, the whole breast received 42.5 Gy and the [umpectomy bed 48 Gy in 16 treatments over 22 days. RESULTS：Totally 46,12,8 patients were enrolled to 3-DCRT,IMRT and h-IMRT group respectively and median follow-up time was 23.9 months （2. 1±48.0 months）. There were not significant differences （P〈0.05） among the three groups in immunohistochemistry, pathological type, tumor node metastasis stages, radiotherapy and chemotherapy regimens, age, the interval between surgery and adiuvant ra diotherapy,maximum diameter of tumor or numbers of lymph node metastasis respectively. The course of h-IMRT groups was the shortest （P〈0.01）. Univariate Analysis of General Linnear Model showed：there were no statistical differences between pre radiotherapy and post radiothera

关 键 词：乳腺肿瘤 保留乳房术 剂量分割 调强放疗 美容 

分 类 号：R737.9[医药卫生—肿瘤]