早期乳腺癌保乳术后调强放疗与常规放疗临床对照研究

A Control Study of Intensity-modulated Radiotherapy Versus Conventional Radiotherapy for Early Stage Breast Cancer after Breast-Conserving Surgery

目的探讨早期乳腺癌保乳术后行调强放疗的近期疗效。方法回顾性分析2007年1月-2009年1月收治的55例保乳治疗后行放疗的早期乳腺癌患者的临床资料,其中28例(50.9%)行调强放疗,27例(49.1%)行常规放疗,两组照射剂量均为全乳腺照射50 Gy/25次,瘤床补量10 Gy/5次,观察临床毒性反应、疗效及美容效果。结果调强放疗组中发生1级急性放射性皮肤反应26例,2级2例,而常规放疗组中分别为19例、8例,调强放疗组较常规放疗组,降低了2级急性放射性皮肤反应的发生率(7.1%vs 29.6%,P<0.05),两组均未发现3、4级急性放射性皮肤反应及乳腺纤维化,两组3年局部控制率、无瘤生存率及远处转移率差异均无统计学意义;随访3年,调强放疗组美容评分均在3分以上,优良率100%,常规放疗组中1例患者出现双侧乳腺对称性差,评分2分,其余26例评分在3分以上,两组患者随访至今未发现明显的放射性心脏、肺毒性。结论早期乳腺癌保乳术后调强放疗降低了2级急性皮肤反应发生率,3年随访,肿瘤局部控制率、无瘤生存率及远处转移率与常规放疗组相比差异无统计学意义,乳腺毒副反应轻,美容效果好,提高了患者的生活质量。

Objective To study the short-term outcome of intensity-modulated radiation therapy（IMRT） for early stage breast cancer after breast-conserving surgery. Methods The clinical data of 55 patients with early stage breast cancer undergoing the radiotherapy after breast-conserving surgery from January 2007 to January 2009 were retrospectively reviewed. Of the 55 patients, 28 cases （50.9%） were treated with IMRT, and the 27 patients （49.1% ） with conventional radiation therapy （cRT）. All patients received whole breast radiation（WBI） （ median dose ,50Gy/25f） followed by a boost to 60 Gy. The median follow-up was 3 years. The skin toxicity,cosmetic effect and clinical outcomes were observed and analyzed. Results Grade 1 of acute radiation skin re- action was seen in 26 patients and grade 2 in 2 patients of patients with IMRT,accordingly, 19 patients and 8 patients were seen in team with cRT. There was not more than grade 2 of skin reaction for all the patients. Treatment with IMRT decreased acute skin toxicity of Radiation Therapy Oncology Group Grade 1 or 2 compared with cRT（ 7.1% vs. 29.6% ; P 〈 0.05 ）. Comparing IMRT with cRT, there were no statistically significant differences in local control raterate at 1 st year,2nd and 3rd year, disease-free sur- vival at 3rd year, and distant metastasis, or second malignancies. Excellent or good cosmetic outcome was 100% at 3rd year in IM- RT group, and one patient was with 2 scores for bad symmetrical characteristic in cRT group, and others were excellent or good in the group. The toxicity of heart and lung was not observed during the follow- up period for all the patients. Conclusion The inci- dence of acute skin toxicity can be decreased by IMRT in patients with early stage breast cancer after breast-conserving surgery. The local control rate in cancer,disease-free survival and distant metastasis rate are similar to the cRT group. The side effects is light, the cosmetic outcome is satisfactory. The life quality of patients can be improved.