乳腺癌改良根治术后辅助调强放疗中胸壁补偿膜放置的效果

Effectiveness of the use of chest wall bolus during adjuvant intensity modulated radiotherapy after modified radical mastectomy

目的分析乳腺癌改良根治术后辅助调强放疗中胸壁未放置补偿膜的复发率,探讨补偿膜放置的必要性。方法以2013年1月—2019年6月收治的218例乳腺癌改良根治术后辅助调强放疗病例为研究对象,术后放疗全程胸壁未放置补偿膜,分析放疗后胸壁复发率。结果住院记录、门诊记录、本市居民健康系统、电话等方式随访至2021年6月31日,随访率100%,平均随访时间48.9个月。放疗后出现胸壁复发为3例,其中1例单纯胸壁复发、2例合并区域淋巴结复发,胸壁复发率为1.4%。3例出现胸壁复发的乳腺癌患者中,其中2例患者TNM分期为N3、HER2阳性,1例患者为三阴性,3例患者出现局部复发时均伴有远处转移。218例患者中,5例出现Ⅰ度放射性皮肤反应,3例出现Ⅱ度放射性皮肤反应,未出现Ⅲ度或Ⅳ度放射性皮肤反应;218例病例胸壁皮肤均未出现Ⅲ/Ⅳ度急性放射性损伤。结论乳腺癌改良根治术后辅助适型/调强放射治疗,在系统的全身治疗情况下,如果治疗前肿瘤没有侵犯皮肤,胸壁放疗时可考虑不放置补偿膜。

Objective To analyze the recurrence of breast cancer without use of chest wall bolus during adjuvant intensity modulated radiotherapy after modified radical mastectomy,so as to investigate the necessity of bolus use.Methods A total of 218 patients undergoing adjuvant intensity modulated radiotherapy after modified radical mastectomy during the period from January 2013 to June 2019 were enrolled as the study subjects.The chest wall bolus was not used during the whole period of radiotherapy after modified radical mastectomy,and the recurrence of breast cancer in the chest wall was analyzed after radiotherapy.Results The post-surgical follow-up through outpatient records,inpatients records,local residents’health system and telephone was performed until June 31,2021.The proportion of follow-up was 100%,and the mean follow-up period was 48.9 months.There were three cases with breast cancer recurrence in the chest wall,including one case with recurrence in the chest wall alone and two cases with recurrence in the chest wall and regional lymph nodes,and the overall recurrence of breast cancer was 1.4%in the chest wall.Among the 3 cases with breast cancer recurrence in the chest wall,there were two cases with N3 stage and positive for HER2,and one triple-negative breast cancer case,and all three cases developed distal metastases upon local recurrence.Among 218 study subjects,there were 5 cases with gradeⅠradioactive skin reaction,3 cases with gradeⅡradioactive skin reaction,and no gradeⅢorⅣradioactive skin reaction occurred.In addition,no gradeⅢorⅣacute radioactive injury was seen in the chest wall skin among the 218 study subjects.Conclusion No use of chest wall bolus may be considered during adjuvant intensity modulated radiotherapy after modified radical mastectomy in presence of systemic therapy if tumor invasion into skin is not observed prior to therapy.