我国乳腺癌改良根治术后放疗现状的调查分析

Survey of current status of post-mastectomy radiotherapy for breast cancer in China

目的为了全面了解我国目前乳腺癌根治术或改良根治术后放疗(简称术后放疗) 的现状,特开展此项研究.方法对全国所有开展放疗的单位分别于2003年1～3月邮寄调查表 ,对乳腺癌术后放疗的适应证和放疗技术等进行两轮问卷调查. 结果乳腺癌术后放疗适应证中包含T1～T2期病变及位于内象限或中央区、T1～T2期淋巴结转移1～3个、T3期或淋巴结转移≥4个的单位比例分别为11.9%、63.8%、87.6%和97.1%,其中仅以T3期或淋巴结转移≥4个为术后放疗主要适应证的单位只占7.1%.在放疗靶区中,常规照射锁骨上下区的单位最多, 占96.2%,其余依次为内乳区85.2%、胸壁79.0%和腋窝74.8%.胸壁照射以60Co或高能 X线切线野照射最多见(45.2%),单纯电子线照射占28.3%,60Co或高能X线与电子线混合照射占 25.3%;34.3%的单位在照射中胸壁加垫填充物;胸壁的中位照射剂量是50 Gy(30～60 Gy ).腋窝照射以60Co或高能X线为主(86.6%),与电子线混合照射占12.7%;有65.6%的单位采用腋后野补量照射技术;腋窝中位照射剂量是50 Gy(40～64 Gy).锁骨上下区也以 60Co或高能X线照射为主(61.4%),与电子线混合照射占33.7%;锁骨上下区中位照射剂量是50 Gy(40～ 60 Gy ).内乳区单纯60Co或高能X线照射占49.7%,与电子线混合照射占33.0%,单纯电子线照射占15.6%;内乳区中位照射剂量也是50 Gy(40～60 Gy).结论目前我国对肿瘤≥5 cm 或淋巴结转移≥4个的乳腺癌进行术后放疗的看法比较一致,但对T1～T2期淋巴结转移1～3个的患者是否需要术后放疗的看法尚存分歧,有待进一步的前瞻性临床研究来证实.

Objective To study the way of applying post-mastectomy radiotherapy in the treatment of breast cancer in China. Methods Two cycles of questionnaire were sent to the departments of radiation oncology of different hospitals through out China to survey the indications and techniques of post-mastectomy radiotherapy for breast cancer. Results Proportions of hospitals which applied post-mastectomy radiotherapy to breast cancer of stage T1-T2N0, T1-T2N0 with tumor located in the center or inner quadrant of the breast, T1-T2N ＋ 1-3 and T3 or N ＋≥14 were 11.9% ,63.8% ,87.6% and 97.1%. Proportion of hospitals in which only 33 or N ＋≥4 were the standard indication of post-mastectomy radiotherapy was 7.1%. As to irradiation targets, the supra- and infra-clavicular region was the most common target in 96.2% of different hospitals, followed by inner quadrant region （85.2%）, chest wall （79.0%） and axillary region （74.8%）. Conclusions We have the same standpoint that breast cancer of stage 33 or N ＋≥14 should receive post-mastectomy radiotherapy. However, there is controversy in the decision making of radiotherapy for stage T1-T2N ＋ 1-3 breast cancer, which is worth further prospective clinical trials for a final conclusion.