术中放射治疗应用于乳房保留手术——病例分析(2015~2018)  

Intra-Operative Radiotherapy in Breast Conserving Surgery—Cases Analysis (2015-2018)

作　　者：容菁霞 郑翠芬 柯卉玲 

机构地区：[1]新光吴火狮纪念医院,一般外科,台湾台北 [2]新光吴火狮纪念医院,放射肿瘤科,台湾台北

出　　处：《世界肿瘤研究》2018年第2期69-74,共6页World Journal of Cancer Research

摘　　要：普及式的全民乳房影像筛检(45~69岁女性)已施行多年,使得早期乳癌的发现率提高。对于早期乳癌的手术方式,根据国外NCCN (National Comprehensive Cancer Network)及国内的建议,皆鼓励医师尽量施行“保留式乳房切除”以维持患者的身体外观及双侧乳房平衡,避免因为身形的缺陷,导至生活的不便或产生心理层面的遗憾。在过去乳癌手术中,保留式乳房切除后,必须再加上三十五日的术后“全乳房”放射治疗,才能达到与全乳房切除相等的安全性。而全乳房照射无可避免的会使被照射之乳房产生皮肤纤维化、皮肤硬化或皮肤表面血管扩张(Telangiectasia)之副作用,也会使乳头乳晕颜色变深或失去弹性。最严重的副作用是因上述的状况,产生严重的疤痕、挛缩,遂使患侧乳房受到牵引拉扯而变形。美国FDA在2012年核准了“术中放射治疗”的施行,也即在手术中施行一次性放射线照射,只需8~10分钟,即可有效的避免了上述全乳照射的缺点;同时对术后的安全性也和全乳照射相等[1]。本院于2015年开始施行术中放射治疗(IORT: Intra-operative radiotherapy)于大部份早期(第一、二期)乳癌,领先于台北市各大医院;迄今已施行了六十例术中放射治疗。其中并无即刻的术后并发症(如伤口感染、伤口愈合不良等)或发生延迟性术后并发症(如皮肤硬化、血管增生等)。而追踪至今,亦无案例发生局部复发或是远程转移。根据统计,本院接受术中放射治疗的患者,普遍上也呈现满意的回馈。所以术中放射治疗在早期乳癌之治疗应考虑为一安全及可行的术式。Regular mammography screening project for Taiwan Residents women aged 45~69 years has been ad-ministered for about 15 years which has achieved a good result in detection of early breast cancer and reduction in breast cancer mortality. According to NCCN (National Comprehensive Cancer Network) guideline, breast conserving surgery (BCS) is recommended for low grade breast cancer, because it provides better cosmetic effect and life quality compared to radical mastectomy. BCS combined with post-operative whole breast irradiation is a standard therapy for low grade breast cancer in previous practice because it provided same overall survival as traditional mastectomy. Inevitably, whole breast irradiation may yield some skin complications such as skin fibrosis, scle-rosis, telangiectasia and even cause hyperpigmentation of nipple-areolar complex with lack of elasticity. Moreover, it may result in deformity of ipsilateral breast and alter psychological effect. FDA has approved the administration of intraoperative radiation therapy (IORT) in patients with breast cancer undergoing breast conserving surgery since 2012. It provided same level of safety as traditional post-operative whole breast irradiation and avoided aforementioned side effects [1]. Our institute started to perform IORT in low grade breast cancer since 2015. 60 patients received IORT and there were no apparent immediate or delay complication since then. Besides, no local recurrence or distant metastasis was detected during cancer surveillance. IORT is considered as a safe and feasible option in treatment of low grade breast cancer.

关 键 词：早期乳癌 术中放射治疗 乳房保留手术 

分 类 号：R73[医药卫生—肿瘤]