| 岳丹,杨永净,赵玲,卜明伟,李忠,刘士新,吴洪芬.早期乳腺癌保乳术后加速部分乳腺照射对比全乳腺照射瘤床推量照射的临床研究[J].中华放射医学与防护杂志,2018,38(9):664-669 |
| 早期乳腺癌保乳术后加速部分乳腺照射对比全乳腺照射瘤床推量照射的临床研究 |
| Efficacy analysis of accelerated partial breast irradiation versus whole breast irradiation with simultaneous integrated boost after breast-conserving surgery for early-stage breast cancer |
| 投稿时间：2018-04-16 |
| DOI：10.3760/cma.j.issn.0254-5098.2018.09.005 |
| 中文关键词: 乳腺癌保乳术 加速部分乳腺照射 全乳腺照射 瘤床同步推量照射 疗效 |
| 英文关键词:Breast-conserving surgery Accelerated partial breast irradiation (APBI) Whole breast irradiation (WBI) Simultaneous integrated boost (SIB) Efficacy |
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| 中文摘要: |
| 目的 对比早期乳腺癌保乳术后加速部分乳腺照射（ABPI）和全乳腺照射瘤床同步推量照射（WBI-SIB）两种放射治疗模式的临床疗效，从经济学角度进行分析，为术后辅助放疗模式的选择提供参考。方法 回顾性分析355例早期乳腺癌保乳术后放疗患者。其中177例患者接受ABPI，178例患者接受WBI-SIB。计算生存率，放疗不良反应采用NCI-CTC 3.0评估，美容评价依据Harris美容级别标准，并进行成本分析。结果 中位随访42个月（5.8~92.7个月）。ABPI组和WBI-SIB组的3年无局部区域复发生存率（LRFS）分别为98.2%和97.6%，无远处转移生存率（DMFS）分别为94.3%和93.7%，无疾病进展生存率（DFS）分别为93.1%和91.6%，总生存率分别为95.5%和94.3%，差异均无统计学意义（P>0.05）。与WBI-SIB组相比，ABPI组的2级以上急性不良反应发生率由5.6%降至3.4%（χ2=6.044，P<0.05），2级以上晚期不良反应由5.6%降至2.3%（χ2=6.149，P<0.05），美容效果优良率由88.8%提高到93.8%（χ2=5.22，P<0.05），且平均治疗时间由36.2 d缩短了26.5 d（χ2=40.76，P<0.05）。结论 早期乳腺癌保乳术后ABPI和WBI-SIB的临床疗效相似，前者的急性和晚期不良反应更低，美容效果更佳，经济成本更低，可作为早期乳腺癌保乳术后放疗治疗模式的良好选择。 |
| 英文摘要: |
| Objective To evaluate the efficacy of accelerated partial breast irradiation (APBI) and whole breast irradiation (WBI) with simultaneous integrated boost (SIB) from the perspective of economics, and provide a reference for postoperative adjuvant therapy mode selection for early-stage breast cancer after breast-conserving surgery. Methods A total of 355 early-stage breast cancer patients who underwent APBI or WBI-SIB after breast-conserving surgery were evaluated on efficacy and cost-effectiveness, of which 177 patients received APBI, and 178 patients received WBI-SIB. Survival analysis was done according to treatment received. NCI-CTC 3.0 was used to score the toxicities. Breast aesthetic outcome were evaluated with Harris standards. Results Median follow-up was 42 months (5.8-92.7 months). The 3-year locoregional recurrence free survival(LRFS) rates in APBI group and WBI-SIB group were 98.2% and 97.6%, distant metastasis free survival(DMFS) were 94.3% and 93.7%, disease-free survival (DFS) were 93.1% and 91.6%, and overall survival 95.5% and 94.3%, respectively, without statistically significant differences(P>0.05). Compared with WBI-SIB group, the acute reaction rates in APBI group decreased from 5.6% to 3.4%(χ2=6.044, P<0.05), and late reactions from 5.6% to 2.3% (χ2=6.149, P<0.05), while the cosmetic outcome improved from 88.8% to 93.8%(χ2=5.22, P<0.05). Moreover, the processing average time was shortened by 26.5 d (χ2=40.76, P<0.05). Conclusions After breast-conserving surgery, the efficacy of APBI showed no difference from WBI-SIB with respect to 3-year local control, disease-free survival, and overall survival, but displayed a significantly better toxicity profile and cost-effectiveness ratio for early breast cancer patients. It can be used as a good radiotherapy model after breast-conserving surgery in early-stage breast cancer. |
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