摘要
目的比较早期乳腺癌患者保留乳房（简称保乳）手术后行全乳大分割并瘤床同步加量24 d短疗程放射治疗（简称放疗）与44 d常规分割方案的近期疗效、不良反应和美容效果。方法选择2011年1月至2011年12月天津医科大学肿瘤医院收治的保乳术后病理分期为p T1~2N0~1M0的早期乳腺癌患者共80例,应用随机数字表法将患者分为短疗程放疗组（40例）和常规放疗组（40例）。短疗程放疗组（简称短程组）患者行全乳两野切线放射治疗,单次剂量为2.4 Gy,共18次,总剂量为43.2 Gy,同步行瘤床电子线推量照射,单次剂量为0.4 Gy,共18次,瘤床总剂量为50.4 Gy,总疗程24 d;常规放疗组（简称常规组）患者行全乳两野切线放射治疗,单次剂量为1.8 Gy,共25次,总剂量为45.0 Gy,后续行瘤床电子线推量照射,单次剂量为2.0 Gy,共7次,瘤床总剂量为59.0 Gy,总疗程44 d。采用KaplanMeier法计算患者的局部复发率和生存率,用Log-rank检验比较两组间的差异,并用χ2检验比较两组间不良反应及美容效果的差异。结果中位随访时间37个月,随访率为100%。两组患者的3年生存率均为100%（χ2〈0.001,P=1.000）,且均无一例局部复发。短程组与常规组相比,0~1级、2级急性皮肤不良反应发生率均相似[82.5%（33/40）比77.5%（31/40）,χ2=0.313,P=0.576;17.5%（7/40）比22.5%（9/40）,χ2=0.313,P=0.576];1级皮肤及皮下组织晚期不良反应发生率也相似[22.5%（9/40）与20.0%（8/40）,χ2=0.075,P=0.785];美容效果优良率也相近[67.5%（27/40）与72.5%（29/40）,χ2=0.238,P=0.626]。放疗引起的血液学毒性主要表现为1~2级的中性粒细胞减少和1级血小板下降,并且短程组与常规组的发生率接近[12.5%（5/40）比10.0%（4/40）,χ2=0.125,P=0.724;2.5%（1/40）比5.0%（2/40）,P=1.000]。结论早期乳腺癌患者保乳术后行全乳大分割并瘤床同步加量放疗可以缩短术后放疗疗程,近期疗效好,且不影响美容效果,也不加重皮肤不良反应,但远期效果还需进行长期随访,进一步研究。
Objective To compare the short-term efficacy,adverse reaction and cosmetic outcome between whole breast irradiation of short-course（ 24 d） hypofractionated radiotherapy with concomitant tumor bed boost and conventional regimen（ 44 d） after breast-conserving surgery for early stage breast cancer patients.Methods A total of 80 patients with p T1-2N0-1M0 breast cancer treated by breast-conserving surgery in Cancer Institute and Hospital,Tianjin Medical University from January 2011 to December 2011 were divided into shortcourse radiotherapy group（ n = 40） and conventional radiotherapy group（ n = 40） using a random number table method.In short-course radiotherapy group,40 patients received whole breast radiation of 43. 2 Gy（ 2. 4 Gy each fraction,18 fractions） with concomitant tumor bed boost of 7. 2 Gy（ 0. 4 Gy each fraction,18 fractions）（ total dose： 50. 4 Gy,duration： 24 d）. In conventional radiotherapy group,40 patients received whole-breast radiation of 45. 0 Gy（ 1. 8 Gy each fraction,25 fractions） followed by tumor bed boost of 14. 0 Gy（ 2. 0 Gy each fraction,7 fractions）（ total dose： 59. 0 Gy,duration： 44 d）. Kaplan-Meier method was used to calculate the local recurrence and overall survival,and the differences between two groups were analyzed by Log-rank test.χ2test was used to compare the differences in adverse reaction and cosmetic outcome between the two groups. Results All patients were followed up for median 37 months,and the follow-up rate was 100%. The 3-year overall survival rates in two groups were both 100%（ χ2〈 0. 001,P = 1. 000）. No patient developed local recurrence.The incidence of grade 0- 1 acute adverse reaction of skin was 82. 5%（ 33 / 40） in short-course radiotherapy group and 77. 5%（ 31 / 40） in conventional radiotherapy group（ χ2= 0. 313,P = 0. 576）,and the incidence of grade 2 adverse reaction was 17. 5%（ 7 / 40） in short-course radiotherapy group and 22. 5%（ 9 / 40）in conventional radiotherapy group（ χ2= 0. 313,P = 0. 576）. The adverse reaction of skin and subcutaneous tissue in grade l developed in 22. 5%（ 9 / 40） of short-course radiotherapy group and 20%（ 8 / 40） of conventional radiotherapy group（ χ2= 0. 075,P = 0. 785）. Totally 67. 5%（ 27 / 40） of patients in short-course radiotherapy group and 72. 5%（ 29 / 40） of patients in conventional radiotherapy group had good cosmetic outcome（ χ2= 0. 238,P = 0. 626）. The radiotherapy-induced blood toxicity was mainly manifested as grade 1 to2 neutropenia and grade 1 thrombocytopenia,the former occurred in 12. 5%（ 5 / 40） of patients in short-course radiotherapy group and 10%（ 4 / 40） of conventional radiotherapy group（ χ2= 0. 125,P = 0. 724）,and the latter occurred in 2. 5%（ 1 / 40） of short-course radiotherapy group and 5%（ 2 / 40） of conventional radiotherapy group（ P= 1. 000）. Conclusion Short-course whole breast hypofractionated radiotherapy with concomitant tumor bed boost can shorten the duration of postoperative radiotherapy,and obtain good short-term effect without affecting cosmetic effect or increasing the skin adverse reactions,however,long-term effects need to be confirmed by long-term follow-up and further study.
出处
《中华乳腺病杂志（电子版）》
CAS
CSCD
2015年第3期163-167,共5页
Chinese Journal of Breast Disease(Electronic Edition)
关键词
乳腺肿瘤
外科学
放射疗法
放射治疗剂量
治疗结果
Breast neoplasms
Surgery
Radiotherapy
Radiotherapy dosage
Treatment outcome
