乳腺癌保乳治疗疗效及不良反应分析

The Efficacy and the Side-Effect of the Breast Conservation Therapy for 139 Patients with Breast Cancer

目的：研究乳腺癌保留乳房手术加术后放疗的疗效、不良反应及美容效果。方法：以2001年7月—2008年3月139例保乳术后放疗的乳腺癌患者为保乳组,88例行改良根治术后患者作为非保乳组。根据肿块大小、腋窝淋巴结状态、雌激素和孕激素受体状态、发病年龄、肿瘤位置、HER-2蛋白表达水平、病理分型、治疗模式8个变量对保乳手术患者和改良根治术的患者进行匹配分组,两组齐同可比。保乳术后全乳切线照射46~50Gy（平均剂量49.4Gy）,瘤床追加电子束照射10Gy。患侧锁骨上野剂量：X线30Gy加电子束20Gy。改良根治术88例患者中,有20例行常规患侧锁骨上野及内乳野照射,16例行患侧锁骨上野及胸壁照射。结果：保乳治疗组患者的复发率为2.2%（3/139）,转移率为1.4%（2/139）,生存率为99.3%（138/139）;改良根治组复发率为4.5%（4/88）,转移率为3.4%（3/88）,生存率为97.7%（86/88）。在所有随访患者中,3例病死,其中保乳组1例,改良根治组2例。这3例患者均死于乳腺癌的转移。保乳手术组与改良根治术组间总体生存率和无病生存率均无显著性差异（P〉0.05）。保乳组患者对乳房美观的满意率为90.6%（126/139）。保乳组患者的放疗不良反应中,75.3%为I级反应,17.3%为II级反应,仅1例出现III级迟发性毒性反应。无皮肤和软组织坏死、乳房及上肢水肿等并发症发生。结论：保乳综合疗法（保乳手术＋放疗）安全、可靠,其短期生存率和局部复发率与同病期改良根治术患者比较无显著差异,美容效果满意,并发症发生率低,可保全患者的生理功能和社会心理状态,提高其生活质量。

Objective：This study was to evaluate the efficacy,side-effects and cosmetic effects of breast conserving operation plus radiotherapy.Methods： A matched study using data on patients derived from a prospectively collected breast cancer database was conducted.The database included patients who received MRM or BCT from 2001 to 2008 in our hospital.The match was conducted according to eight variables： tumor size,axillary lymph node status,sexual hormone receptor,Her-2 expression level,therapy strategy,tumor location,histopathology type and age at diagnosis.Cases were patients who received BCT（n=139）.Control group were patients who received MRM（n=88）.In BCT group,tangential field irradiation was used with dose of 46-50 Gy.Tumor bed was irradiated additional 10 Gy with electron beams.Supraclavicular field irradiation was also used with dose of 50 Gy.Among the 88 cases treated with MRM,20 cases were treated with supraclavicular field irradiation plus internal mammary radiation,and 16 cases were treated with supraclavicular field irradiation plus chest wall.Results： The recurrence rate,metastasis rate and survival rate were 2.2%（3/139）,1.4%（2/139）,and 99.3%（138/139）,respectively in BCT group,and were 4.5%（4/88）,3.4%（3/88）,and 97.7%（86/88）,respectively in MRM group.Three patients were dead of breast cancer metastasis,one in BCT group,the others in MRM group.The overall survival（OS） and disease free survival（DFS） in MRM and BCT patients have no difference（P0.05）.According to JCRT′s standard we evaluated the postoperative cosmetic appearances,the satisfaction rate is 90.6%（126/139）.In breast-conserving therapy group,74.8% of the radiation side-effects were grade I and 17.3% were grade II.Late toxicity reaction developed only in one case（grade III）.Conclusions： In early stage of breast cancer,the survival rate and cosmetic effects of breast-conserving therapy were satisfactory while the incidences of radiation side-effects were low.Thus for legible early stage breast cancer breast-conserving therapy should be the best choice.