术中放疗在早期乳腺癌保乳治疗中的临床应用  

Application of intraoperative radiotherapy in early stage breast cancer

作　　者：万明辉[1] 伍锐[1] 潘凌霄[2] 郑文博[2] 牛道立[1] 

机构地区：[1]广州医科大学附属第一医院放疗科,广州510120 [2]广州医科大学附属第一医院乳腺外科,广州510120

出　　处：《南通大学学报（医学版）》2017年第3期203-205,共3页Journal of Nantong University(Medical sciences)

基　　金：国家自然科学基金青年基金资助项目(81402203)

摘　　要：目的:探讨早期乳腺癌保乳术中采用低能X线局部放疗取代常规术后全乳放疗的安全性和可行性。方法:对广州医科大学附属第一医院2012年12月—2016年12月收治的23例早期乳腺癌女性患者采用INTRABEAM移动式术中放疗系统行保乳手术后联合局部术中放疗(intraoperative radiotherapy,IORT)。观察初步治疗效果、切口愈合情况、美容效果及不良反应。结果:中位随访时间24.6个月,截至随访日,出现区域淋巴结复发后行淋巴结切除术1例(4.35%),全部患者均未出现远处转移,无死亡病例。出现切口感染2例(8.70%),出现切口延迟愈合2例(8.70%),中位愈合时间15 d。有切口水肿1例(4.35%)。未见切口脂肪液化或血肿。美容效果评价:优秀或良好19例(82.61%),一般或差4例(17.39%)。不良反应:未见术中放疗相关急性血液学毒性。5例(21.74%)出现轻度皮肤色素沉着。结论:术中X线放疗临床安全性高,近期疗效尚可,美容效果好,不良反应小,并发症少见,可以在早期乳腺癌保乳手术中联合应用。Objective： To investigate the safety and feasibility of intraoperative radiotherapy during breast-conserving surgery instead of whole breast radiotherapy in female patients with early breast cancer. Methods： From December 2012 to December 2016, 23 early breast cancer patients underwent breast-conserving surgery plus interoperative radiotherapy by INTRABEAM mobile linear accelerator. Postoperative recurrence and metastases ,complications and cosmetic outcomes were recorded and analyzed. Results： During a median follow-up period of 24.6 months, 1 patient（4.35%） underwent regional lymph node dissection after local-regional relapses. There was no recurrence of distant metastasis or mortality. Their average wound healing time was 15 days and 2 of them（8.70%） developed infection while another 2（8.70%） had delayed wound healing. And 1 patient（4.35%） showed wound edema and neither fat necrosis nor hematoma was found. The evaluation of cosmetic outcome shows 19 patients（82.61%） were graded as excellent or good while another 4 patients（17.39%） fair or poor. None had radiotherapy-related acute hemotological toxicity and 5 patients（21.74%） developed skin pigmentation. Conclusion： Intraoperative radiotherapy during breast-conserving surgery instead of whole breast radiotherapy in early breast cancer patients is both safe and reliable with better cosmetic outcomes.

关 键 词：乳腺肿瘤 保乳手术 术中放射疗法 

分 类 号：R737.9[医药卫生—肿瘤]