瘤床同步推量在早期乳腺癌保乳术后大分割容积调强放疗中的可行性及安全性  

Feasibility and safety of simultaneous integrated boost in volumetric modulated arc therapy for early breast cancer after breast-conserving surgery

作　　者：郑斯明[1] 胡冰霜 周嘉雄 李民英[1] 古定标[1] 李珍[1] 余建荣[1] Zheng Siming;Hu Bingshuang;Zhou Jiaxiong;Li Minying;Gu Dingbiao;Li Zhen;Yu Jianrong(Department of Radiotherapy,Zhongshan People's Hospital,Zhongshan 528400,China)

机构地区：[1]中山市人民医院放疗科,中山528400

出　　处：《肿瘤研究与临床》2022年第10期750-754,共5页Cancer Research and Clinic

摘　　要：目的探讨瘤床同步推量(SIB)技术应用于早期乳腺癌保乳术后大分割容积调强放疗(VMAT)的可行性及患者不良反应。方法选取中山市人民医院2019年9月至2021年5月收治的67例早期乳腺癌保乳术后患者,均采用VMAT-SIB技术照射整个乳房和瘤床,全乳剂量和瘤床剂量分别为每3周40.5 Gy/15次和48 Gy/15次,评估危及器官的受照剂量,评价放疗急性不良反应。结果全乳计划靶区(PTV_(WB))和瘤床计划靶区(PTV_(BOOST))剂量分别为(42.0±2.1)Gy和(49.9±0.8)Gy,PTV_(WB)的V_(95%)和V_(105%)分别为(98.8±1.2)%和(31.4±11.3)%;PTV_(BOOST)的V_(95%)和V_(105%)分别为(99.8±0.6)%和(22.9±10.2)%,V_(5Gy)、V_(20Gy)、V_(30Gy)及平均剂量(D_(mean))分别为(52.4±12.0)%、(15.3±4.5)%、(6.7±2.2)%及(11.0±2.4)Gy;心脏的V_(18Gy)、V_(40Gy)分别为3.80%(0.48%,9.60%)、0(0,0.16%),D_(mean)为(6.7±2.1)Gy。放疗结束时,19例(29%)患者的急性皮肤不良反应为0级,41例(61%)患者出现放射性红斑,5例(7%)患者出现放射性干性脱皮,2例(3%)患者出现湿性脱皮,主要位于乳头、乳晕区及乳房皱褶处。未出现3、4级皮肤不良反应,乳房肿胀及乳房疼痛患者分别为9例(13%)和7例(10%)。随访期间未发现患者发生局部区域复发及远处转移,2年无病生存率为100%。结论VMAT-SIB技术治疗早期乳腺癌是可行的,且早期不良反应轻,耐受性良好。Objective To investigate the feasibility and adverse reactions of simultaneous integrated boost(SIB)in volumetric modulated arc therapy(VMAT)for early breast cancer after breast-conserving surgery.Methods A total of 67 patients with early breast cancer after breast-conserving surgery at Zhongshan People's Hospital from September 2019 to May 2021 were enrolled.All patients received VMAT-SIB to the whole breast and tumor bed.The total breast dose and tumor bed dose were 40.5Gy/15 times every 3 weeks and 48 Gy/15 every 3 weeks respectively.The exposure dose of organs at risk and acute adverse reactions of radiotherapy were evaluated.Results The average doses of planning target volume of the whole brease(PTV_(WB))and planning target volume of the boost(PTV_(BOOST))were(42.0±2.1)Gy and(49.9±0.8)Gy,respectively.The V_(95%) and V_(105%) of PTV_(WB) and PTV_(BOOST) were(98.8±1.2)% and(31.4±11.3)%,(99.8±0.6)% and(22.9±10.2)%,respectively.The V_(5Gy),V_(20Gy),V_(30Gy) and mean dose(D_(mean))of ipsilateral lung were(52.4±12.0)%,(15.3±4.5)%,(6.7±2.2)%and(11.0±2.4)Gy respectively.The V_(18Gy),V_(40Gy) and D_(mean) of heart were 3.80%(0.48%,9.60%),0(0,0.16%)and(6.7±2.1)Gy respectively.At the end of radiotherapy,19 patients(29%)of all 67 patients had no acute skin toxicity,41 patients(61%)showed radiation erythema,5 patients(7%)had radioactive dry peeling and 2 patients(3%)had wet peeling mainly located in the nipple,areola area and breast folds.None of the patients had grade 3-4 acute skin reactions.Breast swelling and breast pain were found respectively in 9 patients(13%)and 7 patients(10%).No local recurrence or distant metastases were observed during the follow-up period.The 2-year disease-free survival rate was 100%.Conclusions VMAT combined with SIB is feasible in the treatment of early breast cancer.The adverse reactions of radiotherapy are mild and well tolerated.

关 键 词：乳腺肿瘤 保乳术 同步瘤床推量 大分割放疗 容积旋转调强 

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