早期乳腺癌保乳术后部分乳腺快速调强放疗26例临床观察

Clinical observation of accelerated partial-breast intensity-modulated radiotherapy in patients with early-stage breast cancer after breast-conserving surgery

目的观察早期乳腺癌保乳术后部分乳腺快速调强放疗的临床可行性。方法2008年1月至2010年1月北京大学肿瘤医院收治的26例低危复发风险的早期乳腺癌保乳手术后的患者，实施部分乳腺快速逆向动态调强照射，处方剂量为34Gy，10次5d完成。评价急性放射性皮肤反应，随访其临床疗效。结果26例患者均按预定计划完成放疗，放疗期间10例患者出现轻度1级急性放射性皮肤反应（皮肤温度升高），放疗结束后1个月，26例患者均出现1级急性放射性皮肤反应（轻度色素沉着），无1级以上急性放射性皮肤反应；放疗结束后3个月患者皮肤反应基本消失。中位随访期51（35—59）个月，随访期满3年的23例，随访期内均未发现局部复发，3年无病生存率100％。2年的美容效果优良率为100％。结论早期乳腺癌保乳术后部分乳腺快速调强放疗急性毒性反应小，可获得满意的美容效果和临床疗效。

Objective To explore the clinical feasibility of accelerated partial breast irradiation （APBI） by intensity-modulated radiotherapy （IMRT）. Methods Twenty-six patients with T1N0M0 breast cancer were enrolled into a prospective accelerated partial-breast IMRT protocol between January 2008 and January 2010. Inverse planning of IMRT was employed at a prescribed dose of 34 Gy/10 175 d. Acute radiation skin responses and clinical effects were observed. Results All of them completed radiation. During the radiation, Grade 1 of acute radiation skin reaction （mild hyperpigmentation ） was seen in 8 patients and there was not 〉 grade 2 of skin reaction. At Month 1 post-radiation, Grade 1 of acute radiation skin reaction （ mild hyperpigmentation ） was seen in all patients and there was not 〉 grade 2 of skin reaction. At Month 3 post-radiation, all instances of acute radiation skin reactions recovered. The median follow-up period was 51 months （ range ： 35 - 59）. The follow-up period of 23 patients were over 3 years. No local recurrences developed. The 3-year disease-free survival was 100%. Cosmesis was good or excellent in all cases at Year 2. Conclusion External beam-partial breast irradiation delivered by IMRT is feasible for selected Chinese early-stage breast cancer patients after breast-conserving surgery. The cosmetic effect, local control rate and long-term survival rate are satisfactory. And acute radiation toxicity is quite low.