乳腺癌保留乳房手术后放疗114例疗效分析

Analysis of efficacy results in 114 breast cancer patients with breast conserving treatment and radiotherapy

目的:观察乳腺癌保留乳房手术后放疗的疗效和美容效果,探讨乳腺癌保留乳房手术后局部复发的相关因素。方法:收集1995-01-2006-12在我院行全乳放疗的保留乳房手术后的乳腺癌患者114例,观察其放疗反应、美容效果、局部复发及远处转移,应用Kaplan-Meier法计算无复发生存率、无转移生存率和总生存率,并分析局部复发的相关因素。结果:中位随访44个月,保留乳房手术后患者的放疗反应为1～2级。放疗后乳房外形总满意率为95.6%。局部复发2例,远处转移3例(死亡1例)。5年复发率为1.8%,5年转移率2.6%。5年无复发生存率97.5%,5年无转移生存率97.3%,5年总生存率96.4%。复发的相关因素分析:其中1例未做瘤床加量,放疗后2个月同部位复发;1例术后切缘阳性、ERPR阴性HER-2阳性,放疗后9个月同部位复发。结论:乳腺癌保留乳房手术后放疗反应轻微,美容效果良好。确保放疗瘤床加量的实施、手术切缘阴性是降低局部复发的重要因素。

OBJECTIVE： To investigate the effect of radiotherapy and cosmetic results for the patients with breast cancer after breast conserving treatment. And to analyze the dangerous factors of local recurrences. METHODS： A total of 114 patients with breast cancer received breast conserving treatment followed by whole breast radiotherapy in our hospital from January, 1995 to December, 2006, were collected. The side effect of radiotherapy, cosmetic effect, local recurrences and distant metastasis were observed. The reeurrence-free survival, distant metastasis-free survival, and overall survival with Kaplan-Meier method were calculated. And the dangerous factors of local recurrences were analyzed. RESULTS： All the Patients were followed up with the median period 44 months. The side effect of the whole-breast radiotherapy was from 1 to 2 grade. The satisfaction rate of cosmetic effect was 95.6%. Two cases experienced local relapse, distant metastases were found in 3 cases （1 case died）, the 5 year recurrence rate was 1.8%, the 5 year distant metastasis rate was 2.6%. the 5 year recurrence-free survival rate was 97.5%, the 5 year distant metastasis free survival rate was 97.3% and the 5 year overall survival rate was 96.4%. The analysis of the dangerous factors of local recurrences： one case without a boost dose, recurred 2 months after radiotherapy, the other one with positive surgical margin, ER（ - ） PR（ - ） HER 2 （ ＋＋- ）, recurred 9 months after radiotherapy. CONCLUSIONS： The side effect of the radiotherapy after breast conserving treatment is mild. And the cosmetic effect is satisfactory. To ensure a boost dose and negative surgical margin is the important factor to degrade local recurrences.