早期乳腺癌保乳术后不同剂量调强放射治疗效果及不良反应

Efficacy and side effects of early stage breast cancer in the treatment of different doses of intensity modulated radiotherapy after breast conserving surgery

目的探讨早期乳腺癌保乳术后调强放疗治疗的合适剂量。方法选取2010年6月～2013年1月湖州市中心医院住院的早期乳腺癌保乳术女性患者256例为研究对象，按照随机分配原则将其分为方案一组128例和方案二组128例。比较不同放射剂量下两组患者的近期疗效和3年内生存率，记录放疗后不良反应发生情况。结果①两组目标靶区中V95%、V105％、V115%与靶区剂量均匀性指数（HI）比较，差异均有统计学意义（P〈0．05），不同放射剂量的调强放疗后乳腺靶区的剂量分布具有明显差异。②方案二组总有效率显著高于方案一组，差异有统计学意义（P〈0．05）；两组3年内的累积生存率差异无统计学意义（P〉0．05）。③方案二组患者各级临床不良反应发生率均低于方案一组，差异均有统计学意义（P〈0．05）。结论合适的调强放疗剂量能优化乳腺靶区内剂量分布的均匀性，降低不良反应的发生率。

Objective To evaluate the suitable dose of intensity modulated radiotherapy for patients with early stage breast cancer after breast conserving surgery. Methods 256 female patients with early stage breast cancer after breast conserving surgery from June 2010 to January 2013 in Central Hospital of Huzhou City were selected and divided into option 1 group with 128 cases and option 2 group with 128 cases based on the principle of random assignment. Impacts of different doses of intensity modulated radiotherapy on short-term therapeutic effect and three-year survival rate were compared in patients of the two groups. The side effects were recorded after intensity modulated radiotherapy. Results ①The differences of V95%, V105%, V115% HI between the two groups were statistically significant （P 〈 0.05）, the dose distribution in the target of different doses of intensity modulated radiotherapy was significantly different. ②The overall effectiveness power in option 2 group was significantly higher than that in option 1 group, the difference was statistical- ly significant （P = 0.014）; and the difference of three-year accumulate survival rate between the two groups was not statistically significant （P 〉 0.05）. ③The clinical adverse reactions incidence of each level in option 2 group was lower than that in option 1 group, the difference was statistically significant （P 〈 0.05）. Conclusion Suitable dose of intensity modulated radiotherapy for patients with early stage breast cancer after breast conserving surgery can promote the dose distribution in the target and reduce the incidence rates.