早期乳腺癌保乳手术术中电子线照射的初步报告

Preliminary report of intraoperative radiotherapy with electrons in breast-conserving surgery of early breast cancer patients

目的：研究早期乳腺癌保乳手术术中放射（ELIOT）治疗的可行性，评价术后并发症和术后乳房外观。方法：2007年6月至2009年6月间共有26例早期乳腺癌（肿瘤直径不超过2.5厘米）患者接受了乳腺癌保乳手术及术中放疗,放疗剂量为21Gy（生物学效应相当于常规分割照射58～60Gy）。术后1年内第1、2、3个月,第6、9、12个月,1年后每6个月评估一次，主要评估切口愈合状况、并发症、乳房外观及肿瘤复发事件。结果：切口愈合天数为14～22天，平均17天。随访2～25个月（平均随访时间12个月）中，有2例出现切口脂肪液化，11例有切口水肿伴引流液较多，全组未出现术后切口感染或血肿。在随访期间，未发现局部复发,远处转移或对侧乳腺癌。手术切口愈合后、术后半年、1年、2年对乳房外观评价结果：评价为优秀的比例分别依次为57.7%、66.7%、72.7%及100%；评价为好的分别依次为34.6%、22.2%、9.1%及0.0%；评价为一般的分别依次为7.7%、11.1%、9.1%及0.0%；本组未出现评价为差的患者。结论：开展的26例乳腺癌保乳术后ELIOT 2年多的随访结果显示该治疗方法疗效确切、安全，对于合适的早期乳腺癌患者是一安全的选择。

Objective To investigate the feasibility of applying intraoperative radiotherapy with electrons （ELIOT） after conservative surgery in limited-stage breast carcinoma and to evaluate late effects and cosmetic results after this new conservative treatment. Methods From June 2007 to June 2009, 26 patients affected by unifocal breast carcinoma up to a diameter of 2.5cm received a wide resection of the breast followed by ELIOT. All patients received 21Gy intraopertively, biologically equivalent to 58 to 60 Gy in standard fractionation. Patients were evaluated 1 to 3, 6, 9 and 12 months after surgery, and thereafter every 6 months, to look for cosmesis results and early,intermediate, late complications and other events. Results The average wound healing time is 14 to 22 days, mean time 17 days. After a follow-up from 2 to 25 months（mean time, 12months）, 2 patients developed fat deliquescence, 11 patients showed wound edema and excess fluid and no one had incision infection or hematoma. No patients developed local relapses or distant metastases; and no contralateral breast cancer occurred. Overall cosmesis after breast-conserving surgery and ELIOT was rated after wound healed, 6 months, one year and two years post operation. Excellent was rated in 57.7%,66.7%,72.7% and 100% patients successively. Good was rated in 34.6%, 22.2%,9.1% and 0.0% patients, fair in 7.7%, 11.1%,9.1% and 0.0% patients. No patient was rated poor. Conclusions ELIOT is a safe method for treating conservatively operated breasts. Results on short-term and middle-term toxicity up to 2 years of follow-up are good. Data on local control are encouraging.