保乳术后放疗加后装插植治疗与加电子线放疗远期疗效观察

The Long-term Efficacy Observation of Whole-breast External Beam Radiation Therapy after Breast Conserving Surgery Coupled with Brachytherapy or Local Electronic Boost Radiation

目的：观察早期乳腺癌保乳手术后常规全乳放疗加后装插植治疗与加电子线补量照射的长期疗效及美容效果．方法回顾性分析1995年1月至2003年12月在昆明医科大学第三附属医院就诊的早期乳腺癌患者，要求肿块最大直径≤3 cm，显微镜下手术切缘阴性，腋窝淋巴结清扫为阴性，病理类型为浸润性导管癌．选取有随访资料的53例；其中23例术后使用6MV-X线切线野常规分割全乳房照射46-50 Gy/23-25次，局部瘤床区用高剂量率后装插植补量8-10 Gy/1-2次，30例对照组电子线加量照射10 Gy/5次．治疗后2 a内每3个月，第3-5年每6个月，之后每年随访1次观察治疗和美容效果．结果全组病例随访217个月（平均165个月），插植组2例分别在治疗后62个月和158个月死于远处转移，美容效果优良率均超过78%．无局部复发，局控率100%．3、5、10、15 a生存率分别为100%、100%、95.7%、88.3%；电子线组3例分别在治疗后45个月、97个月、87个月死于远处转移，美容效果优良率均超过80%．有1例局部复发，局控率97.0%；3、5、10、15 a生存率分别为100%、96.7%、93.6%、82.3%个月，2组局部复发率、生存率和美容效果比较没有差别（P〈0.05）．结论早期乳腺癌保乳术后6MV-X线切线照射加瘤床后装插植治疗与电子线野局部加量比较，疗效及美容效果相当、生存质量高，治疗时间短.

Objective To summarize the long term effect of the whole-breast external beam radiation therapy after breast conserving surgery coupled with brachytherapy or local electronic boost radiation. Methods The survival rate and cosmetic results were retrospectively analyzed for 96 patients with early stage breast cancer received breast conserving surgery and hormone therapy from January 1995 to December 2003 in Yunnan Tumor Hospital. The enrolled conditions included single lesion, tumor maximum diameter ≤ 3cm, microscopically negative surgical margin, negative axillary lymph node dissection, and pathological type of invasive ductal carcinoma. 53 cases with comprehensive follow-up data were selected. Among them, 23 cases were treated with whole breast tangent conventional fractionated irradiation： 46-50 G/23-25 fractions, local tumor bedarea with high dose-rate brachytherapy： 8-10 Gy/1-2 fractions in postoperative,and 30 cases in control group were treated with electron beam irradiation of 10 Gy/5 fractions. The efficacy and cosmetic results were observed in every three months within two years,in every six months from three to five years, and in every year five years later. Results All the patients＆amp;nbsp;were followed up for 217 months （average follow-up 165 months）, of which 2 patients died of distant metastasis 62 months and 158 months later after treatment. The excellent cosmetic result was more than 78%, and no local recurrence was observed in the group. The 3-,5-,10-and 15-years survival rates were 100%,100%,95.7%and 88.3%,respectively. In control group,3 patients were died of distant metastasis 46 months,97 months and 87 months later after treatment,also with excellent cosmetic results. There was only one case of local recurrence,and the local control rate was 97.0%. The 3-,5-,10-and 15-years survival rates were 100%,96.7%,93.6%and 82.3%, respectively. There was no significant difference in local recurrence and survival rates between the two groups （P〈0.05） . Conclusion Both radiation brachytherapy and electronic boost have the same effect and good cosmetic results. The radiation brachytherapy shows a high quality of life and a short treatment time.