乳腺癌保乳术后同步加量IMRT前瞻性研究

A prospective study of intensity-modulated radiotherapy with integrated boost after breast conservative surgery in breast cancer patients

目的 前瞻性评估乳腺癌保乳术后瘤床同步加量IMRT的疗效和不良反应.方法 2006-2010年共入组128例Ⅰ-Ⅲ期保乳术后乳腺癌患者.剂量分割方案为全乳50 Gy分25次（2Gy/次）,瘤床同步加量至60 Gy分25次（2.4 Gy/次）.不良反应评估采用CTCAE3.0标准.乳房美容效果评估依据哈佛系统.Kaplan-Miere法生存分析.结果 随访率100％.5年LRRFS为98.4％、DMFS为95.3％、OS为97.7％.急性皮肤反应1级65.6％、2级15.6％、3级2.3％;放射性肺炎1级22.5％、2级4.7％.37例（28.9％）患者出现1、2级上肢水肿.远期1例（0.8％）患者出现全乳色素脱失,4例（3.1％）出现色素沉着.放疗前、放疗后5年美容效果评价为优或良的分别为85.9％、77.3％.21.9％为一般,1例为差.结论 乳腺癌患者保乳术后接受同步加量IMRT 5年疗效理想,急慢性不良反应较轻,整体耐受良好,美容效果较好.

Objective To prospectively evaluate the efficacy and toxicity of intensity modulated radiotherapy （IMRT） with integrated boost after conservative surgery in breast cancer patients.Methods From January 2006 to June 2010,128 patients with stages Ⅰ-Ⅲ breast cancer treated with breast conservative surgery were recruited.All patients received whole breast IMRT with integrated tumor bed boost.A total dose of 50 Gy in 25 fractions with 2 Gy per fraction was delivered to the whole breast,while 60 Gy with 2.4 Gy per fraction was delivered to the tumor bed concomitantly.Supraclavicular fossa was irradiated to 50 Gy in 9 patients （7.1%） who had more than 3 involved axillary lymph nodes.104 patients （81.3%） received chemotherapy.93 （94.9%） of the 98 patients who had positive hormone receptor received endocrine therapy.Cosmetic evaluation is based on the Harvard system.Acute and late toxicities were scored according to CTCAE version 3.Survival rates were calculated by Kaplan-Miere method.Results The following-up rate was 100%.The 5-year locoregional recurrence-free survival,disease-free survival and overall survival was 98.4%,97.7%,and 95.3%,respectively.The acute skin toxicity was grade 1 in 65.6%,grade 2 in 15.6%,and grade 3 in 2.3% of all patients.Grade 2 radiation pneumonitis （RP） developed in 4.7% of this cohort,grade 1 in 22.5%.Grade 1-2 arm edema developed in 28.9%.One patient （0.8%）developed whole breast depigmentation.Four patients （3.1%） developed chromatosis.77.3% of patients hadquot; excellent or good＂ cosmetic outcome at 5 years,compared to 85.9% of patients before radiotherapy.However,28 patients （21.9%） had＂ fair＂ cosmetic outcome and 1 patient had＂ poor＂ appearance at 5 years.Eighteen patients （14.1%） experienced improved cosmetic outcome at 5 years compare to that before radiotherapy while 34 patients （26.6%） had an inferior appearance.Conclusions IMRT with integrated boost after breast-conserving surgery for breast cancer patients is well tolerated,with relatively good cosmetic outcome and moderate toxicity.Meanwhile,5-year local control and survival are excellent.