Ⅱ、Ⅲ期乳腺癌术后三种放疗方式的比较研究

Comparison study of three irradiation methods for postoperative stage Ⅱ and III breast cancer

目的:探讨Ⅱ、Ⅲ期乳腺癌术后适宜的胸壁和锁骨上区照射方式。方法:156例患者随机分成A、B、C三组,给予不同放疗方式。A组锁骨上区和胸壁给予常规电子线照射,2Gy/次,1次/d,5d/周,总量至50Gy。B、C组电子线放疗至32Gy后,分别改用4野调强和三维适形切线放疗,剂量均为DT18Gy分9次11d完成。比较三组不良反应和疗效。结果:三组放射性皮肤反应发生率、胸壁复发率无差异(P>0.05);放射性肺损伤发生率分别为32.7%、10.4%、22.6%(P<0.05),B组最低,A组最高;远处转移率分别为36.3%、8.3%、37.7%(P<0.01),B组最低,A、C两组无差异。结论:三种放疗方式在皮肤反应和局部控制率上无差别;电子线+4野调强能减少放射性肺损伤发生,而对控制远处转移发生的作用尚需进一步研究。

Objective： To evaluate the proper radiotherapy methods for postoperative stageⅡand III breast cancer in receiving radiotherapy on the chest wall and upper clavicle area. Methods： Total of 156 cases were divided into three groups according to different radiotherapy methods. Group A was given full rang electron-radiotherapy of 50Gy/25f.Group B and C were respectively given 18Gy/9f of four fields intensity modulated radiotherapy and three-dimensional conformal radiotherapy after conventional electron-radiotherapy of 32Gy/16f. The effect and side effect were compared. Results： There were no statistical differences in the incidence of radioactive dermatitis and rate of chest wall recurrence in three groups （P0.05）. There were statistical differences in the occurrence of radiation- induced lung injury（P0.05） and rate of distant metastasis in three groups （P0.01）. The occurrence of radiation-induced lung injury was lowest in group B and group A was the highest.For distant metastasis rate, the group B was the lowest and there were no differences between group A and group C. Conclusion： The three radiotherapy methods have same incidence of radioactive dermatitis and local recurrence rate . Conventional and four fields intensity modulated radiotherapy is able to significantly decrease the occurrence of radiation-induced lung injury. The role of controlling distant metastasis is unclear.