乳腺癌术后放疗后胸壁大面积复发的再次放疗

SALVAGE RADIOTHERAPY FOR EXTENSIVE LOCALLY RECURRENT BREAST CANCER FOLLOWING CHEST WALL POSTOPERATIVE IRRADIATION

目的 探讨乳腺癌术后、放疗后胸壁大面积复发再次放疗的方法。 方法 总结我院自１９９４ 年４ 月～１９９８ 年６ 月间，应用两种不同的放疗方法治疗１７ 例胸壁表浅复发面积超过１００ｃｍ２ 病人的疗效观察。７ 例近距离贴敷治疗，经ＣＴ定位，靶区边缘剂量６～８Ｇｙ次，共３ 次，１０～１５ｄ 内完成。常规放疗１０ 例，选用１０ ＭｅＶ电子线加１ｃｍ 胸壁蜡块补偿３０～５０Ｇｙ１５～２５ 次１９～３３ ｄ６ 例；１０ ＭＶ光子加楔型板双切线野＋１０ ＭｅＶ电子线４ 例，４４～６０Ｇｙ２２～３０ 次３０～４０ｄ。 结果 近距离贴敷治疗结束一个月后，８６ ％（６７ 例） 病灶基本消失，无呼吸系统症状。常规治疗组６０％ （６１０）病灶３ ～５ 个月临床症状完全消退。２０％ （２１０）出现放射性肺炎。 结论 经ＣＴ定位，优化设计的近距离贴敷放疗方法，局部控制率较高，肺受量小。

PURPOSE To evaluate the methods of salvage radiotherapy for extensive locally recurrent breast cancer following chest wall postoperative irradiation.METHODS Form April 1994 to June 1998,17 patients with prior treatment for breast cancer by postoperative irradiation,and presenting a superficial widespread inoperable chest wall recurrence(>100?cm 2),underwent two methods of radiotherapy for salvage.7 cases were treated by highdose rate plesiocurietherapy.with CT scan and TPS optimization process,6～8?Gy(4～5 mm under the skin surface) 2 or 3 courses within 10～15 d;10 cases were treated by conventional external irradiation,30～50?Gy with 10 MeV electron beam and 1?cm compensation material,(6 cases);or plus two tangential fields with total dose of 44～60?Gy/30～40?d(4?cases).RESULTS 6/7cases (86%) achieved complete clinical regression locally one month after the plesiocurietherapy without evident respirational complication.And in the conventional radiotherapy group,6/10 cases(60%) presented a local control 3～5 monthes after the treatment,but 2 had radiation pneumonitis.CONCLUSIONS The high dose rate plesiocurietherapy,plus CT scan and TPS optimization process,is a feasible,effective salvage method for extensive locally recurrent breast cancer following chest wall postoperative irradiation,with high local control probability and low complication rate.