放疗相关症状在乳腺癌术后急性放射性皮炎风险预警中的应用  

Postoperative radiotherapy-related symptoms as predictors of acute radiation dermatitis in breast cancer

作　　者：周严红 耿文慧[1] 高阳[1] 潘烁 李姗姗 张芳 Yanhong Zhou;Wenhui Geng;Yang Gao;Shuo Pan;Shanshan Li;Fang Zhang(Department of Radiation Oncology,The Fourth Hospital of Hebei Medical University,Shijiazhuang 050011,China)

机构地区：[1]河北医科大学第四医院放疗科,石家庄市050011

出　　处：《中国肿瘤临床》2025年第1期24-28,共5页Chinese Journal of Clinical Oncology

基　　金：河北省医学科学研究课题计划项目(编号:20230887)资助。

摘　　要：目的:观察乳腺癌术后放疗患者照射区症状纵向变化,探讨放疗期间预测急性放射性皮炎的相关症状指标。方法:本研究为前瞻性纵向研究设计,采用便利抽样法选取2022年5月至2022年12月于河北医科大学第四医院103例接受三维适形放射治疗的乳腺癌根治术后患者为研究对象,患者共放疗50 Gy/25次,每周观察照射区瘙痒、疼痛、肿胀、灼热、紧绷感5个症状,共6次。比较不同程度放射性皮炎相关症状的发生情况,计算发生2级及以上放射性皮炎的最佳症状个数,应用受试者工作特征曲线(ROC)评价其预测效果,应用二元Logistic回归比较不同症状个数与放射性皮炎发生的风险。结果:103例患者纳入研究,症状的严重程度总评分分别为0(0,0)、0(0,0)、0(0,1)、1(0,2)、2(1,3)、3(2,4),呈现逐渐上升趋势。从放疗20 Gy/10次至放疗结束,症状评分与基线差异具有统计学意义(P均<0.001)。从放疗30 Gy/15次至放疗结束,2级及以上皮炎组症状得分高于2级以下皮炎组(Z=2.12、2.81、4.08,P=0.034、0.005、0.001)。放疗50 Gy/25次结束时,瘙痒、疼痛、肿胀、紧绷、灼热的发生率分别为68.9%(71例)、68.9%(71例)、46.6%(48例)、36.9%(38例)、15.5%(16例)。放疗30 Gy/15次、40 Gy/20次时最佳的预测症状个数分别为2个、3个,ROC曲线下面积分别为0.632、0.666,敏感度分别为48.6%、43.2%,特异性分别为77.3%、81.8%(95%CI:0.517~0.746、0.558~0.775,P=0.027、0.005)。用最佳截断值将受试者分为低风险组和高风险组,二元Logistic回归显示,高风险组发生2级及以上放射性皮炎的风险是低风险组的3.39、3.58倍(OR=3.388,95%CI:1.400~8.197,P=0.007;OR=3.584,95%CI:1.430~8.985,P=0.006)。结论:放射性皮炎的症状早期已出现,且随皮炎程度加重而增加,应密切观察患者照射野区域的症状,放疗30 Gy/15次症状个数≥2个、40 Gy/20次症状个数≥3个时2级及以上放射性皮炎的发生风险增加。Objective:To observe the longitudinal changes of symptoms in the irradiation area of patients with postoperative radiotherapy for breast cancer,and investigate the correlative symptom indexes for predicting acute radiation dermatitis during radiotherapy.Methods:This study was designed as a prospective longitudinal study.A total of 103 patients with breast cancer who received three-dimensional conformal radiotherapy in The Fourth Hospital of Hebei Medical University from May 2022 to December 2022 were enrolled using convenience and purposive sampling methods.The patients received a total of 50 Gy/25 radiotherapy sessions.We conducted weekly observations of five symptoms-itching,pain,swelling,burning,and tightness-in the irradiated area,for a total of six weeks.The incidence of symptoms associated with radiation dermatitis across different severity levels was compared.We calculated the optimal number of symptoms for the occurrence of grade 2 or higher radiation dermatitis,evaluated the predictive effect using the subject's work characteristic curve(ROC),and compared the risk of radiation dermatitis with the number of symptoms by applying a binary Logistic regression.Results:A total of 103 patients were included in the study.The total severity scores of symptoms were 0(0,0),0(0,0),0(0,1),1(0,2),2(1,3),3(2,4),respectively,showing a gradually increasing trend.From the 20 Gy/10-fraction radiotherapy point onward to the completion of radiotherapy,symptom scores exhibited statistically significant deviations from baseline values(P<0.001).From the beginning of 30 Gy/15 sessions to the end of radiotherapy,symptom scores were higher in patients with grade 2 and above dermatitis compared to those with dermatitis of less than grade 2(Z=2.12,2.81,4.08,P=0.034,0.005,0.001);at the end of 50Gy/25 sessions,the incidence rates of pruritus,pain,swelling,tightness,and burning were 68.9%(71 cases),68.9%(71 cases),46.6%(48 cases),36.9%(38 cases),and 15.5%(16 cases),respectively.At the 30 Gy/15 and 40 Gy/20 radiotherapy sessions,the opt

关 键 词：乳腺癌 急性放射性皮炎 症状 预测 

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