局部晚期乳腺癌改良根治术后多西他赛同步放化疗的放射性不良反应观察

Adverse reactions of chemoradiotherapy with docetaxel after modified radical mastectomy in locally advanced breast cancer

目的：对比观察局部晚期乳腺癌改良根治术后多西他赛同步放化疗与序贯放疗的放射性不良反应，评估多西他赛同步放化疗模式的安全性、可行性。方法：收集2009年1月至2014年12月广西医科大学第四附属医院155例女性乳腺癌病例，患者均行乳腺癌改良根治术，病理诊断为乳腺浸润性导管癌，TNM分期为pT3～4pNl～3cM0或P任意rrpN2～3cM0。采用氟尿嘧啶＋表柔比星＋环磷酰胺（FEC）化疗方案后，密闭信封法随机分为同步组（多西他赛化疗时同步放疗）78例、序贯组（多西他赛化疗完成后放疗）77例，观察两组放射性不良反应及近期疗效。结果：中位随访39（16～62）个月。同步组和序贯组的放射性不良反应轻微，均无3～4级放射性皮肤反应、症状性心肺放射损伤。1～2级放射性皮肤反应同步组的发生率为89．7％（70／78）、序贯组为88．3％（68，77），两组比较差异无统计学意义（P〉O．05）。3年无复发生存率同步组为92．3％（72／78），序贯组为81．8％（63／77），两组比较差异具有统计学意义（P=0．046）。结论：局部晚期乳腺癌改良根治术后多西他赛同步放化疗的放射性不良反应轻微，与序贯治疗比较提高了患者的3年无复发生存率，安全可行，可作为局部晚期乳腺癌的治疗选择。

Objective： To compare the adverse reactions of concurrent chemoradiotherapy with docetaxel versus those of sequential and scheduled adjuvant therapy after a modified radical mastectomy in locally advanced breast cancer. Additionally, this work aims to evaluate the safety and feasibility of a synchronous therapy schedule. Methods： A total of 155 female breast cancer patients in the Fourth Affiliated Hospital of Guangxi Medical University were enrolled from January 2009 to December 2014. All the patients were diagnosed with infiltrating ductal carcinoma and stage pT3-4, pN1-3c M0, or pAnyTpN2-3cM0 after modified radical mastectomy. After completing the fluorouracil ＋ epirubicin ＋ cyclophosphamide adjuvant chemotherapy, all the patients were randomly divided into two groups by using the method of sealed envelopes. The synchronous group, which received synchronous chemoradiotherapy with docetaxel, comprised 78 cases. The sequential group, which received radiotherapy following docetaxel chemotherapy, comprised 77 cases. The clinical toxic reactions and effects in both groups were assessed after all schedules. Results： A median follow-up period of 39 （16-62） months showed that the radiation side effects of the synchronous and sequential groups were mild. No patients with 3-4 grade radiation-induced skin reactions or symptoms of heart and lung radiation side effects were reported. The rate of 1-2 grade radiation-induced skin reactions was 89.7% （70/78） in the synchronous group and 88.3% （68/77） in the sequential group, but the difference was not statistically significant （P〉0.0S）. The three-year recurrence-free survival rate was 92.3% （72/78） in the synchronous group and 81.8% （63/77） in the sequential group, and the difference was statistically significant （P=0.046）. Conclusion： Synchronous chemoradiotherapy with docetaxel as adjuvant therapy exhibited mild and tolerable adverse reactions following modified radical mastectomy in locally advanced breast cancer. Compared with the sequential schedule, the synchronous schedule showed a significantly increased three-year recurrence-free survival rate. Therefore, a synchronous chemo- radiotherapy schedule is safe and feasible and can be used as a treatment option for locally advanced breast cancer.