| 夏重升,李苗苗,范敏,刘晓萌,付成瑞,董银萍,李宝生,黄伟.早期乳腺癌保乳术后瘤床同步加量调强放疗的临床观察[J].中华放射医学与防护杂志,2017,37(2):119-124 |
| 早期乳腺癌保乳术后瘤床同步加量调强放疗的临床观察 |
| Clinical outcome of early stage breast cancer treated with simultaneous integrated boost intensity-modulated radiation therapy after breast conserving surgery |
| 投稿时间：2016-10-18 |
| DOI：10.3760/cma.j.issn.0254-5098.2017.02.007 |
| 中文关键词: 乳腺肿瘤 保乳术 瘤床同步加量调强放疗 疗效 不良反应 |
| 英文关键词:Breast neoplasms Breast-conserving surgery Simultaneous integrated boost intensity-modulated radiation therapy Curative effect Side-effects |
| 基金项目: |
|
| 摘要点击次数: 2768 |
| 全文下载次数: 2317 |
| 中文摘要: |
| 目的 探讨早期乳腺癌保乳术后瘤床同步加量调强放射治疗（SIB-IMRT）技术的疗效、不良反应及美容效果。方法 2009年8月-2013年10月山东省肿瘤医院收治的分期为T1-2N0-1M0的乳腺癌保乳术后患者146例，其中60例行序贯瘤床加量调强放疗（常规组），剂量分割方案：全乳1.8~2.0 Gy/次，共45~50 Gy/25次，后续瘤床加量10~16 Gy/5~8次，总疗程42~45 d；86例行SIB-IMRT短疗程调强放疗（SIB组），剂量分割方案：全乳1.8 Gy×28次，瘤床同步加量2.15 Gy×28次，总疗程38 d。采用Kaplan-Meier法计算生存率和局部复发率，χ2检验比较两组资料可比性、不良反应及美容效果。结果 常规组与SIB组1、2、3级急性皮肤反应发生率分别为63.3%与75.8%、20.0%与16.2%、16.7%与8.0%（P>0.05）；0、1、2级皮肤及皮下组织晚期反应发生率分别为84.6%与85.8%、12.2%与10.6%、3.2%与3.6%（P>0.05）；0、1、2、3级中性粒细胞减少发生率分别为22.6%与33.7%、34.6%与40.7%、26.7%与20.9%、15.0%与4.7%（P>0.05）。常规组与SIB组放射性肺炎分别为2例（3.3%）与3例（3.5%）（P>0.05）；美容优良率分别为89.7%与89.2%（P>0.05）。随访24~74个月（中位数38个月），随访率95.2%；两组1、3、5年生存率均为100%。常规组2例出现复发或转移（3.5%），SIB组3例出现复发或转移（3.7%）。结论 保乳术后瘤床同步加量放疗与瘤床序贯放疗疗效相似，美容效果相当且未加重早晚期不良反应，并有缩短疗程的优势。 |
| 英文摘要: |
| Objective To investigate the efficacy, toxicity and cosmetic outcome of simultaneous integrated boost intensity-modulated radiation therapy (SIB-IMRT) for early-stage breast cancer patients after breast-conserving surgery.Methods A total of 146 patients with T1-2N0-1M0 breast cancer after breast-conserving surgery were included. Of which, 60 patients received whole-breast radiation to 45-50 Gy in 25 fractions followed by tumor bed boost of 10-16 Gy in 5-8 fractions and the course of radiotherapy was 42-45 days (C group). The other 86 patients received whole breast radiation to 50.4 Gy in 28 fractions with concomitant tumor bed boost to 60.2 Gy in 28 fractions (S group). Kaplan-Meier method was used to calculate the overall survival rate and local recurrence rate. χ2-test was used to compared the differences of the clinical characteristics, toxicity and cosmetic outcome between the two groups. Results The incidence of grade 1 acute skin toxicity was 63.3% and 75.8%, grade 2 was 20.0% and 16.2%, grade 3 was 16.7% and 8.0% in C and S group (P>0.05), respectively.In C and S group, the incidence of grade 0 late skin and subcutaneous tissue toxicity was 84.6% and 85.8%, grade 1 was 12.2% and 10.6%, grade 2 was 3.2% and 3.6% (P>0.05), respectively. The incidence of grade 0 neutropenia was 22.6% and 33.7%, grade 1 was 34.6% and 40.7%, grade 2 was 26.7% and 20.9%, grade 3 was 15.0% and 4.7% in C and S group (P>0.05) , respectively.There were 89.7% and 89.2% of patients had excellent and good cosmetic outcome in C and S group, respectively (P>0.05), and 3.3% and 3.5% of patients experienced radiation pneumonitis (P>0.05). After a median follow up of 38 months (24-74 months), the follow-up rate was 95.2%. The 1-, 3- and 5-year overall survival rates were 100%.There were 3.5% and 3.7% of patients had local recurrence and/or distant metastatic in C and S group, respectively. Conclusions The efficacy, toxicity and cosmetic outcome of SB-IMRT and SIB-IMRT were similar. Compared with SB-IMRT, SIB-IMRT has an advantage of shortening the treatment period. |
| HTML 查看全文 查看/发表评论 下载PDF阅读器 |
| 关闭 |
|
|
|