同步加速调强放疗在早期乳腺癌保乳术后放疗中的临床研究

Study of Synchrotron Intensity Modulated Radiotherapy in Patients After Breast-Conserving Surgery for Early-Stage Breast Cancer

目的：观察同步加速调强放疗在早期乳腺癌保乳术后放疗的临床疗效和不良反应。方法：选择本院45例于2010年1月-2012年12月接受保留乳房手术切除的早期乳腺癌患者，按照随机数字表法分成研究组和对照组，研究组23例采用全乳放疗并同期加量放疗，1.8~2.4 Gy/d，每周5次。全乳腺照射45 Gy/25F，瘤床区总剂量60 Gy/25 F；对照组22例采用全乳放疗后局部瘤床加量，2 Gy/d，每周5次，全乳腺照射50 Gy/25 F，瘤床区局部加量10 Gy/5 F，总剂量60 Gy/30 F。按RTOG标准评估放疗反应，复发转移率的比较采用χ2检验。结果：两组患者中位随访18个月，研究组23例患者中，1例患者出现同侧锁骨上淋巴结转移，1例出现骨转移，复发转移率为8.70%。患者的放疗反应为1~2级，中位住院放疗时间为30 d。对组照22例患者中1例肝转移，其余均未出现复发和远处转移，复发转移率为4.55%。放疗反应为1~2级，中位住院放疗时间37 d。两组复发转移率比较差异无统计学意义（P=0.968）。结论：同步加速调放疗治疗早期乳腺癌保乳术后患者，缩短了治疗时间，临床疗效良好，放疗反应轻微，值得进一步临床研究及应用。

Objective：To observe the synchrotron intensity modulated radiotherapy in patients after Breast-conserving surgery of early-stage breast cancer clinical effectiveness and toxicity.Method：Forty-five patients who had received breast-conserving surgery for early breast cancer patients in our hospital from January 2010 to December 2012 were randomly assigned to the study group and the control group. Twenty-three patients of the study group were given whole breast radiotherapy and radiotherapy plus the amount of the same period,1.8-2.4 Gy/d,5 times a week. The total dose of whole breast irradiation was 45 Gy/25F,and total dose of tumor-bed was 60 Gy/25F. Twenty-two cases of the control group were given electronic beam after the whole breast radiotherapy to increase the amount of local tumor bed,2 Gy/d,5 times a week. The total dose of whole breast irradiation 50 Gy/25F,increasing the amount of local tumor-bed dose of 10 Gy/5F, total dose 60 Gy/30F. According to RTOG criteria assessed the toxicity reactions,compared the recurrence rate using χ2 test. Result：Two groups of patients with a median follow-up of 18 months. Twenty-three patients in the study group,1 patient had ipsilateral supra clavicular lymph node metastasis,1 case with bone metastasis,recurrence and metastasis rate was 8.70%. Patients with radiation toxicity were mostly grade 1 or 2,with a median time of 30 days hospitalization. Twenty-two patients in the control group had 1 patient with liver metastasis,the recurrence and metastasis rate was 4.55%. Patients with radiation toxicity were mostly grade 1 or 2,with a median time of radiotherapy 37 days hospitalization. Between the two groups of patients recurrence rate,there was no significant difference（P=0.968）.Conclusion：The synchrotron intensity modulated radiotherapy in patients after breast-conserving surgery for early-stage of breast cancer has good clinical effect,and the adverse events are tolerable,more efforts should be made to confirm these results.