螺旋断层调强与固定野调强技术在全乳放疗中的近期临床效果

Early Clinical Results of Whole Breast Irradiation with Helical Tomotherapy or Fixed-field Intensity-modulated Radiation Therapy

目的 研究早期乳腺癌保乳术后应用螺旋断层调强放疗（helical tomotherapy,HT）和固定野调强放疗（fixed-field intensity-modulated radiotherapy,FF-IMRT）的近期疗效和早期临床反应.方法 2012年9月至2013年3月本院使用HT（HT组）和FF-IMRT（FF-IMRT组）进行保乳术后全乳放疗的早期乳腺癌患者共24例,每组12例,术后病理分期0～ⅡB期,全乳放疗剂量46～50 Gy/23～25次.其中接受化疗者11例（45.8％）,接受内分泌治疗者18例（75％）.对两组靶区及危及器官剂量分布进行评估,对放疗毒性反应及美容效果进行评价.结果 与FF-IMRT组相比,HT组的计划靶区（planning target volume,PTV） 105％、PTV110％高剂量区减少（P =0.000,P=0.023）,靶区的均匀性和适形度改善（P =0.003,P=0.002）.患侧肺的V5、V20、Dmean（P=0.002,P=0.001,P=0.000）,双肺的V5、V20、Dmean（P=0.010,P=0.002,P=0.009）及心脏的V5、V20 （P =0.033,P=0.030）等受量降低.HT组出现Ⅰ、Ⅱ级放射性皮炎者分别有10例（83.3％）、2例（16.7％）,FF-IMRT组出现Ⅰ、Ⅱ级放射性皮炎者分别有11例（91.7％）、1例（8.3％）；所有患者均未出现放射性肺炎.HT组患者美容效果为满意者12例（100％）,FF-IMRT组美容效果为满意者11例（91.7％）.两组患者的近期不良反应和美容效果评价差异均无统计学意义.结论 应用HT与FF-IMRT技术进行保乳术后全乳放疗,可获得满意的近期临床效果,长期治疗效果还有待进一步随诊观察.

Objective To observe the early therapeutic effects, toxicities and cosmetic results of whole breast radiotherapy with helical tomotherapy （HT） or fixed-field intensity-modulated radiotherapy （FF-IMRT） in patients with early-stage breast cancer after breast-conserving surgery. Methods From September 2012 to March 2013, 24 patients with stage 0- ]] B breast cancer after breast-conserving surgery were observed. HT and FF-IM- RT were applied in 12 patients after breast-conserving surgery, respectively. The radiotherapy schedule was 46- 50 Gy/23-25 fractions to the whole breast with a boost to the tumor bed to 60 Gy. Eleven patients （45.8%） re- ceived chemotherapy and 18 patients （75%） received endocrine therapy. The targets and the organs-at-risk were evaluated. Toxic and cosmetic results were observed. Results Planning target volume （PTV） 105% and PTV 110% were significantly less for HT than FF-IMRT （P = 0. 000, P = 0. 023 ）. Homogeneity index （P = 0. 003 ） and conformity index （ P = 0. 002） were better for HT than FF-IMRT. HT achieved significant decrease in 5 Gy （ P = 0. 002）, 20 Gy （ P -- 0. 001 ）, and mean dose （ P = 0. 000） for ipsilateral lung. Similar results were obtained for both lungs and heart （ all P 〈 0.05 ）. In the HT group, 10 patients developed grade 1 radiation dermatitis and 2 developed grade 2 radiation dermatitis; in the FF-IMRT group, 11 developed grade 1 radiation dermatitis and 1 developed grade 2 radiation dermatitis. No radiation pneumonitis was observed in all patients. Twelve patients in HT group and 11 patients in FF-IMRT group developed satisfactory cosmetic results （P 〉 0. 05 ）. Conclusions Whole breast radiotherapy with HT or FF-IMRT for patients with early-stage breast cancer after breast-conserving surgery can achieve good therapeutic effectiveness, with satisfactory cosmetic results and acceptable toxicities, although the long-term clinical benefits need further observations.