早期乳腺癌保乳术后低分割瘤床同步加量放疗方法的前瞻性临床研究  

A prospective clinical study of early breast cancer treated with hypofractionated simultaneous integrated boost IMRT/ VMAT after breast conservative surgery

作　　者：马家宝[1] 范羽[1] 许敬辉[1] 郑敏[1] 李睿[1] 罗杨坤[1] 彭瑛[1] 王捷[1] Ma Jiabao;Fan Yu;Xa Jinghui;Zheng Min;Li Rui;Luo Yangkun;Peng Ying;Wang Jie(Department of Radiation Oncology,Sichuan Cancer Hospital,Chengdu 610041,China)

机构地区：[1]四川省肿瘤医院腹部放疗科,成都610041

出　　处：《中华放射医学与防护杂志》2018年第7期505-509,共5页Chinese Journal of Radiological Medicine and Protection

摘　　要：目的 研究早期乳腺癌保乳术后低分割模式的同步加量调强放疗的近期疗效不良反应及美容效果。方法 前瞻性纳入76例分期为TisT1-2N0M0早期乳腺癌保乳术后行低分割同步加量调强适形放疗（IMRT）/容积旋转调强放疗（VMAT）的患者，放疗剂量分割方式为患侧全乳2.65 Gy/次，42.4 Gy/16次，共22 d，瘤床区给予同步加量3.1 Gy/次，49.6 Gy/16次，共22 d。乳房美容效果评估依据哈弗系统，不良反应评估采用常见不良反应事件评价标准（CTCAE）3.0标准。logistic回归分析检验发生2级及以上放射性皮肤反应的相关因素。结果 中位随访29（16-40）个月，随访率为100%。1、2、3年的生存率均为100％，无患者出现复发或转移。1、2级急性皮肤反应发生率分别为52/76（68.4%）和6/76（7.9%）。放疗后晚期1、2级皮肤及皮下组织晚期反应发生率为10/76（13.1%）和2/76（2.6%）。美容优良率为61/74（82.4%）。瘤床的平均剂量与2级及以上放射性皮肤反应相关。结论 早期乳腺癌保乳术后大分割全乳同步瘤床加量调强放疗的近期疗效、美容效果及急性/晚期不良反应均可接受，需要更长时间的随访来进一步证实其安全性。Objective To evaluate the efficacy, toxicity and cosmetic outcomes of hypofractionated simultaneous integrated boost intensity-modulated radiotherapy （IMRT-SIB） after breast conservative surgery （BCS） for early breast cancer patients. Methods A total of 76 patients with stage TisT1-2N0M0 breast cancer treated with BCS were enrolled in the analysis. The patients who underwent breast radiotherapy without regional lymph node irridiation and hypo fractionated IMRT/VMAT were used. All patients received whole breast IMRT/VMAT with tumor bed SIB. The doses delivered to the whole breast was 42.4 Gy in 16 fractions, and the dose delivered to tumor bed for SIB was 49.6 Gy in 16 fractions. Cosmetic evaluation was based on the Harvard system. Acute and late toxicities were scored according to CACAT version 3.0. Survival and recurrence rates were calculated by Kaplan-Meier method. The univariate and multivariate analysis were conducted with logistic regression. Results The median follow-up was 29 months （range 16-40 months）. The follow-up rate was 100%. The 1-, 2- and 3-year overall survival rates were 100%. No recurrence or metastasis was observed in this study. The incidence of grade 1 acute skin toxicity was 68.4%,grade 2 was 7.9%. The late skin toxicity of grade 1 was 13.1%, grade 2 was 2.6%.In all, 82.4% of patients had excellent and good cosmetic outcome. The Mean dose of the tumor bed was predictive factor for grade 2 dermatitis. Conclusion The efficacy, cosmetic effect, the acute and late treatment-related toxicity of hypofractionated IMRT/VMAT-SIB in patients with early breast cancer following BCS might be acceptable. A longer follow-up is needed to define the efficacy on outcomes.

关 键 词：乳腺肿瘤/保乳术 同步加量 放射疗法 低分割放疗 不良反应 

分 类 号：R730.55[医药卫生—肿瘤] R737.9[医药卫生—临床医学]