早期乳腺癌保乳术中电子线照射的初步探讨

Initial Approach of Applying Intraoperative Radiotherapy with Electrons after Conservative Surgery for Patients with Early Breast Cancer

目的探讨早期乳腺癌保乳术中电子线放射治疗（intraoperative radiotherapy with electron,ELIOT）的可行性,评价术后并发症和术后乳房外观。方法2007年6月-2009年6月期间,共有26例早期乳腺癌（肿瘤直径不超过2.5cm）患者接受乳腺癌保乳手术及ELIOT,放疗剂量为21Gy（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情况。结果术后切口愈合时间14~22d,平均17d。随访2~25个月,平均12个月,有2例切口脂肪液化,11例切口水肿伴引流液较多,全组无切口感染或血肿。随访期间内,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6个月,1、2年对乳房外观评价结果：优秀者分别依次为57.7%、66.7%、72.7%及100%;好者分别依次为34.6%、22.2%、18.2%及0;一般者分别依次为7.7%、11.1%、9.1%及0。结论乳腺癌保乳术后行ELIOT疗效确切、安全,对早期乳腺癌患者是一种方法简便,疗效确切、安全的选择。

Objective To investigate the feasibility of applying intraoperative radiotherapy with electrons（ELIOT）after conservative surgery in limited-stage breast cancer and evaluate late effects and cosmetic results after this new conservative treatment.Methods From June 2007 to June 2009,26 patients affected by unifocal breast cancer less than 2.5 cm in diameter received a wide resection of the breast followed by ELIOT.All patients received 21 Gy intraoperatively,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,in cosmesis results and early,intermediate,late complications and other events.Results The average wound healing time was 14 to 22 d,with mean time of 17 d.After a follow-up from 2 to 25 months（mean time 12 months）,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 the wound healed,6 months,1-year and 2-year after operation.The excellent rate was 57.7%,66.7%,72.7% and 100%.The good rate was 34.6%,22.2%,18.2% and 0,the fair rate was 7.7%,11.1%,9.1% and 0.No patient was poor.Conclusion ELIOT is a safe and effective method for early breast cancer after conservative operation.