乳腺癌术后大分割短疗程放射治疗的临床研究

Hypofractionation in postoperative radiotherapy for breast cancer

目的 研究乳腺癌术后大分割放射治疗的疗效、疗程、副反应以及替代常规放射治疗的可能性。方法 6 0例乳腺癌术后需放射治疗病例被随机均分至大分割放射治疗组 (HOFRT组 )和常规放射治疗组 (CRT组 )。两组病例根据TNM分期、腋淋巴结转移数等设内乳野、锁腋野、胸壁野 ,采用 6MVX线、电子线照射 ;HOFRT组的胸壁野照射采用切线对穿野照射。HOFRT组第 1、3天为5 .0Gy/次 ,第 15、17天为 6 .5Gy/次。共DT2 3Gy ,4分次 ,17d完成。CRT组 2 .0～ 2 .5Gy/次 ,共DT4 5～5 0Gy ,2 0～ 2 5分次 ,4～ 5周完成。HOFRT组 10例和CRT组 9例腋窝后野加量 10～ 15Gy ,5～ 7分次 ,5～ 7d完成。HOFRT和CRT组的总疗程分别为 3.1～ 3.4、4 .7～ 6 .0周。结果 HOFRT、CRT组的 5年总生存率分别为 6 5 .8%、76 .9% ;Ⅲ期 5年生存率分别为 5 9.8%、80 .0 % (P >0 .0 5 ) ;局部复发率分别为 10 .7%、7.4 % (P >0 .0 5 )。HOFRT组的局部复发、生存率等与CRT组相似。HOFRT组放射治疗晚期损伤导致的患侧上肢淋巴水肿、活动受限分别为 8、6例 ,与CRT组相似 (CRT为 14、7例 ,P >0 .0 5 )。HOFRT组急性 2～ 3级放射性皮肤损伤显著低于CRT组 (3∶13) ,明显减少由于急性损伤延长放射治疗疗程。结论 大分割放射治疗是一种短疗程、安全、?

Objective To evaluate the effect, duration, toxicity of postoperative hypofractionated radiotherapy(HOFRT) for breast cancer and the possibility of its replacing the conventional radiotherapy(CRT).Methods Sixty operated and accepted such patients were randomized from March 1995 to Dec, 1997, into HORFT(n=30) group and CRT(n=30) group. The internal mammary chain(IMC), chest wall, and axillo-supraclavicular area were treated according to TNM stage and the number of positive axillary lymph nodes.The chest wall was treated by two opposing parallel tangential fields with 6?MV X-ray in the HOFRT group.The axillo-supraclavicular area was treated with 6?MV X-ray plus electron beam. The IMC was treated with 12-14?MeV electron beam.Dose was 23 ?Gy in 4 fractions over 17 days in the HOFRT group(5.0 ?Gy on D1 and 3,6.5 ?Gy on D15 and 17) and 45-50 ?Gy in 20-25 fractions over 4-5 weeks in the CRT group. Ten patients in HOFRT and 9 patients in CRT group had additional boost of 10-15 ?Gy in 5-6 fractions to the axillo-supraclavicular area following the proper treatment. Results The 5-year overall survival rate, 5-year survival rate of stage Ⅲ, locoregional recurrence rate in HOFRT and CRT groups were 65.8% and 76.9%, 59.8% and 80.0%(P>0.05), 10.7% and 7.4%(P>0.05) respectively.Lymphoedema and hypoactivity of the upper arm induced by radiotherapy was milder in the HOFRT group than the CRT group(8 vs. 14,6 vs. 7,P>0.05).CRT significantly increased Grade 3 acute radio-epidermitis which obviously prolonged the course of treatment(3 of 30 patients in HOFRT group, 13 of 30 patients in CRT group,P<0.01). Conclusions HOFRT is safe and effective for breast cancer postoperative treatment. The local recurrence, survival rate and late side effects are comparable in the HOFRT group as compared with that of the CRT group. In the future, it may be possible to replace the conventional radiotherapy by hypofractionated radiotherapy in the treatment of breast cancer.