摘要
目的介绍早期乳腺癌保乳术后单独行局部高剂量率组织间插植加速照射的方法、副作用及美容效果。方法46例Ⅰ、Ⅱ期乳腺癌的47个乳腺在肿瘤局部扩大切除后使用了高剂量率^192Ir组织间插植瘤床区加速照射（APBI）。符合条件的患者包括年龄＞40岁、T1～T2N0～N1（≤3阳性淋巴结），手术切缘＞1～2mm，小叶癌和炎性乳腺癌除外。术后接受高剂量率近距离放疗，2次／d，间隔至少6h，总量34Gy分10次5d完成。治疗后1、6、12个月及以上观察毒性反应及美容效果。结果全组患者随访18～46个月（中位随访34个月），治疗期间急性反应包括红斑、水肿、乳腺触痛和感染共21例（46％），均为1～2级，无3～4级发生。晚期毒性包括皮肤纤维化、乳腺触痛、脂肪坏死及毛细血管扩张1＋2级加例（43％），3级2例（4％），其中1例疗后接受6个周期系统化疗。美容效果达到极好和良好的在6、12个月分别为95％、98％，无一局部复发。结论早期乳腺癌保乳术后APBI后装组织间插植技术具有良好美容功效，急性和晚期毒性作用小，局部控制率有待于长期随访观察。
Objective Objective To study the method, side effects and cosmetic outcome of highdose-rate（HDR） accelerated partial breast interstitial irradiation （APBI） alone in early stage breast cancer after conservative surgery. Methods From February 2002 to June 2003, 47 breast cancer lesions from 46 patients suffering from stage Ⅰ / Ⅱ breast cancer were treated with HDR ^192Ir APBI after conservative surgery. All patients were overdO year-old, with T1-2No-1 （≤3 lymph nodes positive）, surgical margin 〉 1-2 mm, but those having lobular or inflammatory breast cancer were excluded. HDR brachytherapy with 34 Gy, 10 fractions/5 days was used after surgery, toxic reaction and cosmetic outcome were observed in one month, 6 and 12 months respectively. Results Follow up of 18-46 months, 34 months was carried out for the whole group. During the treatment, acute reactions including： erythema, edema, tenderness and infection, all under Ⅰ- Ⅱ grade, none of Ⅲ-Ⅳ grade were observed in 21 patients（46% ）; late toxicity reactions： skin fibrosis, breast tenderness, fat necrosis, and telangiectasia, totally 20 patients（43% ）were observed： 2 patients in m grade but one patient received 6 cycle chemotherapy. The result of cosmetic outcome evaluation was excellent or good, at 6 months 95% and 12 months 98%, respectively, but there was no recurrence. Conclusions Excellent and favorable cosmetic results are noted after APBI by interstitial alone. Acute and late reactions are few. Long term observation is necessary for the rate of local control.
出处
《中华放射肿瘤学杂志》
CSCD
北大核心
2007年第1期25-29,共5页
Chinese Journal of Radiation Oncology
