乳腺癌术后锁骨上淋巴引流区不同照射方式剂量学比较及其对生活质量的影响  

Dosimetry comparison between two different supraclavicular areas irradiation schedules for post-operation breast cancer and its influence on life quality

作　　者：芦玉婷[1] 王坚[1] 林涛[1] 眭建锋 于静萍[1] 倪昕晔[1] 孙苏平[1] 

机构地区：[1]南京医科大学附属常州市第二人民医院放疗科,江苏常州213001

出　　处：《实用临床医药杂志》2016年第19期34-36,共3页Journal of Clinical Medicine in Practice

基　　金：江苏省卫生厅指导性科研项目(Z201220);江苏省常州市卫生局重大项目(ZD201105);江苏省常州市科技支撑社会发展项目(CE20125021)

摘　　要：目的探讨乳腺癌术后乳腺(或胸壁)和锁骨上淋巴引流区整体化调强放疗和分段放疗的剂量学特点。方法根据116例乳腺癌术后患者锁骨上淋巴引流区放疗方式的不同,将患者分为整体调强组(58例)和分段放疗组(58例),观察2组患者皮肤损伤及患侧肩关节活动情况。随机选取10例患者(改良根治术5例,保乳术5例),分别制定锁骨上淋巴引流区调强计划和X线、电子线混合照射计划,对2组计划靶区的适形度、均匀性以及肱骨头受照剂量进行比较。结果 116患者均健康存活,整体调强组有3例患者出现与放疗有关的肩关节症状,分段放疗组未发现与放疗有关的肩关节症状。调强放疗靶区的适形度、均匀性和肱骨头受照剂量比较,差异均有统计学意义(P=0.000)。结论乳腺癌术后锁骨上淋巴引流区调强放疗靶区的适形度、均匀性好于X线、电子线混合照射,肱骨头受照剂量高于X线、电子线混合照射。调强放疗有可能引起肩关节放射性损伤从而影响生活质量。Objective To compare the dosimetric characteristics between integrated intensity modulated radiotherapy（ IMRT） and fractionated radiotherapy（ FR） in breast / thoracic wall and supraclavicular areas for post-operation breast cancer. Methods A total of 116 post-operation breast cancer patients were divided into IMRT group（ n = 58） and FR group（ n = 58） according to the supraclavicular areas irradiation schedules,and skin injury and articulatio humeri activity of affected side were evaluated. Another 10 cases were randomly selected（ 5 cases of modified radical mastectomy,5 cases of breast- conserving）. IMRT and X-electron beam mixed irradiation schedule were applied respectively,and then target conformity,homogeneity and humerus irradiated dose between two groups were compared. Results All the 116 patients survived,radiation related articulatio humeri activity limitation happened in 3 cases and 0 cases in IMRT group and FR group respectively. Target conformity,homogeneity and humerus irradiated dose between IMRT and X-electron beam mixed irradiation showed significant differences（ P = 0. 000）. Conclusion IMRT schedule for supraclavicular areas irradiation in post-operation breast cancer is superior to X-electron beam mixed irradiation,but with higher humerus irradiated dose. IMRT schedule might influence life quality of the patients by inducing articulatio humeri injury.

关 键 词：乳腺癌 术后放疗 肩关节 放射性损伤 剂量学 

分 类 号：R737.9[医药卫生—肿瘤]