早期乳腺癌保乳术后同步加量调强放疗与全乳调强放疗序贯电子线瘤床补量放疗的临床效果比较  

Comparison of clinical efficacy between simultaneous integrated boost intensity-modulated radiotherapy and whole-breast intensity-modulated radiotherapy with sequential electronic boost radiotherapy for early breast cancer after breast-conserving surgery

作　　者：马琴[1] 蒋倩[1] 景娜[1] 王仙玲[1] 马永强[1] 郑苗丽 王玉[1] Ma Qin;Jiang Qian;Jing Na;Wang Xianling;Ma Yongqiang;Zheng Miaoli;Wang Yu(Breast Radiotherapy Ward,Department of Radiotherapy,Shanxi Province Cancer Hospital,Shanxi Hospital Affiliated to Cancer Hospital,Chinese Academy of Medical Sciences,Cancer Hospital Affiliated to Shanxi Medical University,Taiyuan 030013,China)

机构地区：[1]山西省肿瘤医院、中国医学科学院肿瘤医院山西医院、山西医科大学附属肿瘤医院放射治疗科乳腺放疗病区,太原030013

出　　处：《肿瘤研究与临床》2023年第11期845-849,共5页Cancer Research and Clinic

摘　　要：目的比较早期乳腺癌保乳术后同步加量调强放疗和全乳调强放疗序贯电子线瘤床补量放疗的疗效、不良反应及美容效果。方法回顾性分析2015年12月至2017年12月山西省肿瘤医院收治的96例接受保乳术的早期乳腺癌患者临床资料,根据术后放疗方式分为同步加量调强放疗组(观察组,52例)和全乳调强放疗序贯电子线瘤床补量放疗组(对照组,44例)。观察组剂量分割方案为全乳50 Gy/25次(2 Gy/次),瘤床同步加量至60 Gy/25次(2.4 Gy/次),总疗程33~35 d;对照组剂量分割方案为全乳50 Gy/25次(2 Gy/次),后续瘤床推量10 Gy/5次(2 Gy/次),总疗程40~42 d。结果所有患者中位随访70个月,观察组和对照组5年总生存率分别为100.0%、97.7%,5年局部无复发生存率分别为98.1%、95.5%,5年无病生存率分别为98.1%、93.2%,两组总生存、无复发生存、无病生存差异均无统计学意义(χ^(2)=1.18,P=0.277;χ^(2)=0.44,P=0.509;χ^(2)=1.24,P=0.265)。观察组1、2级急性放射性皮炎发生率分别为63.5%(33/52)、19.2%(10/52),对照组分别为50.0%(22/44)、38.6%(17/44),对照组1例(2.3%)发生3级急性放射性皮炎,两组差异有统计学意义(Z=-2.15,P=0.032)。两组急性及晚期放射性肺损伤发生率差异均无统计学意义(均P>0.05)。除对照组1例(2.3%)患者美容效果差外,两组其余患者均达到一般或优良的美容效果(P>0.05)。观察组放疗时间短于对照组,差异有统计学意义(P=0.001)。结论早期乳腺癌患者保乳术后接受同步加量调强放疗或全乳调强放疗序贯电子线瘤床补量均可获得良好的生存获益,美容效果均较好且无严重不良反应。同步加量调强放疗治疗时间更短,患者依从性更佳。Objective To compare the efficacy,adverse reactions and skin cosmetic effects between simultaneous integrated boost intensity-modulated radiotherapy and whole-breast intensity-modulated radiotherapy with sequential electronic boost radiotherapy for early breast cancer after breast-conserving surgery.Methods The clinical data of 96 early breast cancer patients who underwent breast-conserving surgery in Shanxi Province Cancer Hospital from December 2015 to December 2017 were retrospectively analyzed,and the patients were divided into simultaneous integrated boost intensity-modulated radiotherapy group(observation group,52 cases)and whole-breast intensity-modulated radiotherapy with sequential electronic boost radiotherapy group(control group,44 cases)according to the postoperative radiotherapy method.In the observation group,the dose division scheme was 50 Gy/25 fractions(2 Gy/fraction)for the whole breast,while 60 Gy/25 fractions(2.4 Gy/fraction)was used in the tumor bed concomitantly,with a total treatment course of 33-35 d.In the control group,the dose division scheme was 50 Gy/25 fractions(2 Gy/fraction)for the whole breast followed by tumor bed boost of 10 Gy/5 fractions(2 Gy/fraction),with a total treatment course of 40-42 d.Results Median follow-up time of all patients was 70 months,the 5-year overall survival rates of the observation and control groups were 100.0%and 97.7%,the 5-year local recurrence-free survival rates were 98.1%and 95.5%,the 5-year disease-free survival rates were 98.1%and 93.2%,and the differences between the two groups in terms of overall survival,recurrence-free survival and disease-free survival were not statistically significant(χ^(2)=1.18,P=0.277;χ^(2)=0.44,P=0.509;χ^(2)=1.24,P=0.265).The incidence of grade 1 and 2 acute radiation dermatitis was 63.5%(33/52)and 19.2%(10/52)in the observation group,and 50.0%(22/44)and 38.6%(17/44)in the control group,there was 1 case(2.3%)of grade 3 acute radiation dermatitis,and the difference between the two groups was statistically significant(

关 键 词：乳腺肿瘤 乳房切除术 放射疗法 预后 

分 类 号：R737.9[医药卫生—肿瘤]