乳腺癌保乳术＋化疗后动态调强放疗的临床观察

Clinical results of intensity modulated radiotherapy for breast cancer after breast-conserving surgery

目的 观察乳腺癌保乳术＋化疗后动态调强放疗的疗效和美容效果.方法 117例乳腺癌患者保乳术后先行4～6周期化疗再三维适形（6例）和动态调强放疗（111例）.化疗分别采用CAF（环磷酰胺＋多柔比星＋氟尿嘧啶）、AC（多柔比星＋环磷酰胺）、TA（紫杉醇＋多柔比星）、NE（长春瑞滨＋表阿霉素）、TX（紫杉醇＋卡培他滨）方案.放疗采用6 MV-X线全乳腺调强放疗50Gy,瘤床电子线外照射加量10 Gy;其中68例患者锁骨上预防性照射50 Gy,42例肿块位于内侧象限的同时照射内乳淋巴引流区,锁骨上区、内乳区及胸壁均包在一个靶区里.雌、孕激素受体阳性加用内分泌治疗.治疗结束后6～12个月由2位医师评分评价美容效果.结果 随访至2009年9月,随访率为94.0%,随访满3、5年者分别为114、91例.全组3生存率为99.1%,5年生存率为96%,5年无瘤生存率为88%,局部复发率为3.6%,美容效果满意者为100%.放疗中及放疗结束后未出现明显放射性心肺等重要脏器损伤.结论 乳腺保乳术＋化疗后胸壁动态调强放疗使靶区得到更均匀照射,有望提高局部控制率和生存率并降低正常组织并发症、肿瘤复发率.

Objective To analyze the efficacy and cosmetic results of intensity modulate radiation therapy （IMRT） for breast cancer after breast-conserving surgery.Methods From 2003 to 2006, 117 patients with breast cancer, after breast-conserving surgery followed by 4 - 6 cycles of chemotherapy,received intensity modulated radiotherapy （IMRT） or three-dimensional conformal radiotherapy （3DCRT）.The radiation dose was 50 Gy in 25 fractions to the whole breast and 10 Gy boost to the tumor bed.Patients with positive hormone receptors then received endocrine treatment.Results The follow-up rate was 94.0% until September 2009.114 and 91 patients were followed up to 3 and 5 years, respectively.The 3-and 5-year overall survival rates were 99.1% and 96%.The 5-year disease free survival and local recurrence rates were 88% and 3.6%.Cosmetic results were satisfied.Severe radiation toxicities, such as radiation pneumonitis, pulmonary fibrosis and heart injury were not found.Conclusions Patients treated with IMRT after breast-conserving surgery have a satisfied prognosis as well as cosmetic results.