早期乳腺癌保乳术后大分割调强放疗与常规放疗的临床疗效比较

Comparison of clinical efficacy of hypofractionated radiotherapy and conventional radiotherapy for early patients after breast conserving surgery

目的比较早期乳腺癌保乳术后大分割调强放疗和常规放疗的不良反应、美容效果和临床疗效。方法选取本院2014年1月至2016年12月接受保乳术的176例早期乳腺癌(T_(0~2)N_(0~1)M_0)患者并根据治疗方案分为大分割组和常规组,其中大分割组106例患者接受大分割放疗(全乳2.66 Gy/次,共16次,瘤床局部补量2 Gy/次,共5次),常规组70例患者接受常规放疗(全乳2 Gy/次,共25次,瘤床局部补量2 Gy/次,共5次)。观察两组的不良反应(急性和晚期皮肤反应、骨髓抑制情况、放射性肺炎及放射性食管黏膜反应)和美容效果,随访3年后评价局部控制率。结果两组急性放射性皮肤反应发生率的差异无统计学意义(P>0.05);两组放疗过程中骨髓抑制反应、放疗结束后晚期皮肤反应及放射性肺炎发生情况的差异均无统计学意义(P>0.05)。大分割组的美容效果优者96例、良者10例,无中差者,而常规组美容效果优者66例、良者4例,无中差者。两组均对美容效果满意,差异无统计学意义(P>0.05)。大分割组的住院时间和费用较常规组减少(P<0.05)。至末次随访时间,176例患者均生存,大分割组的3年局部控制率为97.1%,1例放疗结束6个月后出现单发骨转移,1例在放疗后1年复查提示同侧锁骨区淋巴结复发。常规组的3年局部控制率为94.3%,2例在放疗后12和18个月出现患侧锁骨区复发。两组局部控制率的差异无统计学意义(P>0.05)。结论乳腺癌保乳术后全乳大分割放疗的不良反应可接受,美容效果较好且能显著降低治疗时间和费用,疗效和同常规放疗差别不大,可应用于临床实践。

Objective To compare the adverse reactions, cosmetic effects and clinical efficacy of hypofractionated radiotherapy and conventional radiotherapy after breast conserving surgery for early breast cancer. Methods One hundred and seventy-six early breast cancer patients （T0.2N0.1Mo） were enrolled in our hospital from January 2014 to December 2016 and were assigned into hypofractionated group （n= 106） and conventional group （n=70）. In hypofractionated group, 106 patients received 16 fractions of 2. 66 Gy for the total breast following 5 fractions of 2 Gy for local tumor bed. In conventional group, 70 patients received 25 fractions of 2 Gy for the total breast following 5 fractions of 2 Gy for local tumor bed. We investigated the toxicity effects （acute and late skin reaction, bone marrow suppres- sion, pharyngeal and digestive tract reaction） and cosmetic effects. The local control rate was evaluated after 3-year follow-up. Results There was no difference of acute radiation-induced skin reactions between both groups （ P 〉 0. 05）. No significant differences were observed in terms of bone marrow suppression reaction, late skin reactions and radiation pneumonitis after radiotherapy between both groups （P〉0. 05）. In hypofractionated group, cosmetic effect was excellent in 96 cases and good in 10 cases without poor beauty, and in conventional group, cosmetic effect was excellent in 66 cases and good in 4 cases without poor beauty. There were sinailar cosmetic effect between both groups （ P〉0. 05）. The length of hospital stay and cost in hypofractionated group were less than those of conventional group （P〈0. 05）. The follow-up rate was 100%. The 3-year local control rates were 97. 1% in hypofractionated group and 94. 3% in convention- al group （P〉0. 05）. As for hypofractionated group, 1 patient exhibited solitary bone metastasis in 6 months and 1 patient exhibited ipsi- lateral supraclavicular lymph node recurrence one year later. As for conventional radiotherapy, 2 patients suffered from recurrent lateral clavicle area at 12 and 18 months after radiotherapy. Conehmlon After breast conserving surgery, the adverse reaction of whole breast hypofractionated radiotherapy is acceptable with better cosmetic effect, and the treatment time and cost can be significantly reduced. The curative effect is similar from that of conventional radiotherapy. It can be applied in clinical practice.