3D-IMRT对乳腺癌保乳术后患者心肺受量和免疫功能影响

Effect of 3D-IMRT on cardiopulmonary response and T cell subsets in patients with breast cancer after breast-conserving surgery and its safety evaluation

目的探讨三维适形调强放疗(3D-IMRT)对乳腺癌保乳术后患者心肺受量、免疫功能的影响。方法选取2019-03-01-2021-01-31大连大学附属中山医院收治的91例乳腺癌保乳术后患者作为研究对象,依据治疗方案不同分为对照组和观察组。对照组45例采用三维适形放疗(3D-CRT),观察组46例采用3D-IMRT。对比2组患者心肺受量、T细胞亚群指标水平及不良反应。结果治疗5周,观察组V_(30)、V_(40)、V_(50)(分别表示心脏接受30、40、50Gy照射体积占整个器官照射体积的百分比)心指数分别为(9.02±1.15)%、(1.17±0.86)%和(0.34±0.12)%,均低于对照组的(10.46±1.32)%、(3.15±1.02)%和(1.06±0.31)%,t值分别为5.552、10.020和14.670,均P<0.001;肺指数分别为(10.14±1.05)%、(3.16±0.48)%和(0.91±0.21)%,均低于对照组的(12.03±1.24)%、(6.35±1.32)%和(2.39±0.61)%,t值分别为7.853、15.385和15.543,均P<0.001。治疗5周,观察组CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+)水平分别为(57.43±7.56)%、(41.83±4.51)%和(1.07±0.29),对照组分别为(63.12±8.24)%、(36.57±3.92)%和(0.91±0.26),2组患者CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+)水平较治疗前均降低,且观察组与对照组比较差异有统计学意义,t值分别为3.430、5.933和2.769,P值分别为0.001、<0.001和0.007。观察组不良反应发生率为4.35%,低于对照组的13.33%,但差异无统计学意义,χ^(2)=1.307,P=0.253。结论3D-IMRT治疗乳腺癌保乳术后患者,通过对机体各区域照射剂量的合理性分布,能够调节T淋巴细胞亚群水平、改善心肺受量,有较高的安全性。

Objective To investigate the effects of three-dimensional conformal intense-modulated radiotherapy(3D-IMRT)on cardiopulmonary response and T cell subsets in patients with breast cancer after breast-conserving surgery and its safety evaluation.Method Totally 91 patients with breast cancer after breast conserving surgery in our hospital from March 1,2019 to January 31,2021 were selected as research subjects,and were divided into control group and observation group according to different treatment regimens.Forty-five patients in the control group received 3D conformal radiotherapy(3D-CRT),and 46 patients in the observation group received 3D-IMRT.Cardiopulmonary response,T cell subsets,toxic and side effects were compared between the two groups.Results The levels of V_(30),V_(40)and V_(50)heart(9.02±1.15)%,(1.17±0.86)%,(0.34±0.12)%and lung index(10.14±1.05)%,(3.16±0.48)%and(0.91±0.21)%in the observation group were lower than those in the control group after 5 weeks of treatment(10.46±1.32)%,(3.15±1.02)%,(1.06±0.31)%,(12.03±1.24)%,(6.35±1.32)%,(2.39±0.61)%(t values was 5.552,10.020,14.670,7.853,15.385 and 15.543 respectively,all P<0.001).The levels of CD3^(+),CD4^(+)and CD4^(+)/CD8^(+)in 2 groups after 5 weeks of treatment were lower than those before treatment.The reduction rates of observation group(57.43±7.56)%,(41.83±4.51)%,(1.07±0.29)were higher than those of control group(63.12±8.24)%,(36.57±3.92)%,(0.91±0.26)(t values was 3.430,5.933 and 2.769 respectively,P values was 0.001,<0.001 and 0.007 respectively).The incidence of adverse reactions in the observation group was 4.35%lower than that in the control group(13.33%),and the difference was not statistically significant(χ^(2)=1.307,P=0.253).Conclusion After 3D-IMRT treatment of breast cancer patients after breast conserving surgery,the rational distribution of radiation dose in various regions of the body can regulate T lymphocyte subsets and improve the dose of heart and lung.