摘要
目的探讨早期乳腺癌保乳术后辅助放疗中,以手术切口外扩确定瘤床范围的准确性。方法选取2014年1月—2016年12月在广州医科大学附属肿瘤医院行保乳术后放疗的患者25例,所有患者均经术后病理证实为T1-2N0-1M0乳腺癌,患侧乳腺术腔用≥3个银夹标记。勾画术腔所有银夹,并勾画标记手术切口的铅丝,将银夹均匀外扩2.0 cm,同时将铅丝均匀外扩1.5、2.0、2.5、3.0 cm,在三维立体图像垂直手术切口皮肤的方向上观察银夹外扩的范围能否完全覆盖手术切口、手术切口外扩的范围能否完全覆盖术腔所有银夹;分别计算银夹均匀外扩2.0 cm(组A)、铅丝均匀外扩2.0 cm(组B)后在垂直手术切口皮肤的方向投影形成的不规则射野的面积及两者重叠部分的投影面积(组C),并计算比例。结果全组25例均为女性,中位年龄49岁,左乳10例,右乳15例,Ⅰ期13例,Ⅱ期12例。留置银夹3枚者3例,4枚者5例,5枚者8例,6枚者9例。银夹外扩2.0 cm覆盖手术切口的比例为89.92%。铅丝外扩1.5、2.0、2.5、3.0 cm覆盖银夹比例分别为83.47%、94.21%、96.69%、99.17%。组C与组A之间差异有统计学意义(P<0.05)。全组C/A范围为49.00%~100.00%,均值为66.73%;(A-C)/A范围为0%~51%,均值为33.27%。瘤床中心距离皮肤距离范围为15~46 mm,平均(35.5±8.36)mm;最浅银夹距离皮肤距离范围为8~34 mm,平均(16.8±9.02)mm。结论乳腺癌保乳术后放疗银夹均匀外扩2.0 cm未能完全覆盖手术切口,且手术切口为外扩标准的瘤床区补量范围不能完全将术腔所有银夹覆盖。以手术切口外扩的瘤床补量方法易造成瘤床区漏照,推荐以术腔标记的银夹为补量的依据。全程光子线照射可能造成靶区欠量。
Objective To explore the accuracy of tumor-bed boost by expanding the operative incision during radiotherapy after breast-conserving surgery in patients with early breast cancer. Methods From January 2014 to December2016,25 patients with early breast cancer who received postoperative radiotherapy in the Cancer Center of Guangzhou Medical University were included in the study. All the patients were confirmed by post-operation pathology with T1-2 N0-1 M0. Using no less than 3 surgical clips to label the tumor bed of affected breast,we outlined all the surgical clips and wires surrounding the operative incision,and expanded surgical clips with an average 2. 0 cm while wires with 1. 5 cm,2. 0 cm,2. 5 cm and 3. 0 cm respectively,to observe whether the expanded tumor bed volume could cover the whole operative incision and vice versa in the direction perpendicular to the operative incision skin with three dimension image in the treatment planning system. Then we calculated the area of the irregular field projected in the direction perpendicular to the operative incision skin in three dimensional image by expanding 2. 0 cm around clips（ Group A）,operative incision（ Group B） and overlap area of them（ Group C） respectively and then figured out the ratios. Results For all 25 female patients,the median age was49; 10 of them developed primary tumors in their left breasts while 15 in right; 13 patients were in stage I and 12 in stage II.3,4,5 and 6 clips were left respectively in 3,5,8 and 9 patients＇ surgical cavities. The ratio of covering operative incision of surgical clips with 2. 0 cm-expansion was 89. 92%,while ratios 83. 47%,94. 21%,96. 69% and 99. 17% were for the expansion of 1. 5 cm,2. 0 cm,2. 5 cm and 3. 0 cm of wires respectively. There was a significant difference between the areas of Group C and Group A（ P 0. 05）. Ratios of C/A in 25 patients were 49. 00%-100%,and 66. 73% in average. Ratios of（ A-C）/A were 0%-51%,33. 27% in average. The distances from the center of tumor bed to skin were 15-46 mm,averagely（ 35. 5 ± 8. 36） mm and the distances from the shallowest clip to skin were 8-34 mm,averagely（ 16. 8 ±9. 02） mm. Conclusion The volume by expanding 2 cm around the surgical clips didn＇t cover the whole operative incision,while the tumor bed boost volume by expanding 1. 5-3. 0 cm around the operative incision couldn＇t cover all the clips in surgical cavity after breast-conserving surgery. Tumor bed boost volume standardized by operative incision expansion may easily result in missing of tumor bed during the boost after whole breast irradiation. Surgical clips are recommended as marks of tumor bed when the tumor bed boost is given. Whole process photon irradiation may lead to lack of target dosage.
出处
《现代医院》
2017年第11期1673-1675,1678,共4页
Modern Hospitals
关键词
乳腺癌
保乳术
放射治疗
瘤床加量
Breast Cancer
Breast Conserving Surgery
Radiotherapy
Tumor-bed Boost
