早期乳腺癌保乳术后全乳IMRT及瘤床大分割同期加量的临床Ⅱ期研究  

Results of a clinical phase Ⅱ trial of whole breast irradiation with a hypofractionated simultaneous integrated boost to the tumor bed after breast-conserving surgery for early breast cancer

作　　者：杨昭志[1] 俞晓立[1] 梅欣[1] 马金利[1] 潘自强[1] 陈星星[1] 张丽[1] 吴炅[2] 邵志敏[2] 陈佳艺[3] 郭小毛[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 [2]复旦大学上海医学院肿瘤学系复旦大学附属肿瘤医院乳腺外科,上海200032 [3]上海交通大学附属瑞金医院放疗科,200025

出　　处：《中华放射肿瘤学杂志》2016年第7期703-707,共5页Chinese Journal of Radiation Oncology

摘　　要：目的 早期乳腺癌保乳术后全乳IMRT及瘤床大分割同期加量的临床Ⅱ期研究。方法 2010—2013年本中心前瞻性收治200例早期乳腺癌保乳术患者,采用IMRT全乳45 Gy分25次同期瘤床加量0.6 Gy/次总量60 Gy5周完成方案。Logistic 回归分析用于检验发生2级放射性皮肤反应的预测因素。结果所有患者均完成放疗。患侧乳腺和瘤床平均PTV为529．2cm^3和92．9cm^3。同侧肺V20为17．2％。左侧乳腺癌患者心脏Dmaan为531cGy。根据CTCAE3．0标准急性放射性皮炎发生率0、1、2级分别为8．0％、63．0％、29．0％，其中发生湿性脱皮者占10．5％。因素分析显示影响2级皮肤反应因素为瘤床PTV、全乳PTV（P=0．031、0．000）。185例患者完成了美容效果自评，其中优、良、一般患者分别为50例（27．1％）、111例（60．0％）、24例（12．9％）。患者中位随访38（2．56）个月，3年LC率为98．7％。结论全乳放疗同期大分割瘤床加量技术可以取得较低的急性皮肤反应和较好的美容效果，3年临床结果显示LC率良好。Objective To report the clinical results of whole breast irradiation with a hypofractionated simultaneous integrated boost to the tumor bed after breast-conserving surgery for early breast cancer. Methods From October 2010 to April 2013, 200 patients with early breast cancer who were admitted to our center and treated with breast-conserving surgery were prospectively enrolled as subjects. All patients received inversely intensity-modulated whole breast irradiation with a dose of 45 Gy in 25 fractions and a simultaneous integrated boost to the tumor bed with a dose of 0.6 Gy/Fx （a total dose of 60 Gy in 25 fractions） five times a week. Logistic regression analysis was used to examine the predictive factors for the occurrence of grade 2 radiation skin reactions. Results All patients completed the radiotherapy treatment. The mean planning target volumes （PTVs） of diseased breast and tumor bed were 529.2 cc and 92.9 cc, respectively. The mean V20 of the ipsilateral lung was 17.2%, and the mean dose for the heart was 531 cGy in patients with left breast cancer. According to the Common Terminology Criteria for Adverse Events, version 3.0, the incidence rates of grade 0, 1, and 2 radiation dermatitis in all patients were 8%, 63%, and 29%, respectively. In all patients, 10.5% had moist desquamation. The multivariate analysis revealed that the PTVs of the tumor bed and whole breast were predictive factors for grade 2 dermatitis. In 185 patients who did self-evaluation of breast cosmetic outcome, 50（87.1%） were rated as excellent, 111（60.0%） as good, and 24（12.9%） as fair. The median follow-up time was 38 months （2-56 months）, and the 3-year local control rate was 98.7%. Conclusions The whole breast irradiation with a hypofractionated simultaneous integrated boost to the tumor bed achieves satisfactory acute skin toxicity profile and cosmetic outcome. A 3-year follow-up reveals a good local control rate.

关 键 词：乳腺肿瘤/保乳术 乳腺肿瘤/放射疗法 放射疗法 同期加量 治疗结果 

分 类 号：R737.9[医药卫生—肿瘤]