医用射线防护剂对比三乙醇胺乳膏防治乳腺癌改良根治术后放疗皮肤损伤临床观察

Clinical effect of medical radiation protective ointment compared with trolamine cream to prevent acute radiation-induced skin injury in breast cancer patients undergoing radiotherapy after modified radical mastectomy

目的 评估医用射线防护剂对比三乙醇胺乳膏对乳腺癌改良根治术后放疗急性放射性皮肤损伤的防治效果.方法 将2017-2018年间接受改良根治术后调强放疗的120例T1-4N1-3M0（Ⅱa-Ⅲc）期乳腺癌患者配对分为医用射线防护剂研究组60例和三乙醇胺乳膏对照组60例（均从第1次放疗开始使用）,对照组出现≥3级皮肤反应时交叉至研究组,观察至放疗后1个月.结果 全组患者急性放射性皮肤反应发生率为100％,研究组82％ 为1级反应,对照组以2级（47％）和3级（13％）皮肤反应为主（P=0.000）.研究组皮肤瘙痒和疼痛程度均低于对照组（P=0.000）.与对照组相比,研究组明显延缓2级皮肤损伤发生（P=0.000）.发生3级皮肤反应者在交叉至研究组或继续使用医用射线防护剂后有不同程度减轻.结论 医用射线防护剂与三乙醇胺乳膏相比,不仅减轻乳腺癌改良根治术后放疗的急性皮肤放射不良反应,而且能延缓皮肤损伤的发生,对3级放射性皮肤损伤有较好的治疗效果.

Objective To access the clinical effect of medical radiation protective ointment compared with trolamine cream to prevent acute radiation-induced skin injury in breast cancer patients undergoing radiotherapy after modified radical mastectomy. Methods Between February 2017 and February 2018,a total of 120 stage T1-4 N1-3 M0 eligible patients received intensity modulated radiation therapy were enrolled and matches into two groups：study group （60 cases） was administered medical radiation protective ointment from the first irradiation fraction,and control group （60 cases） received trolamine cream. When 3 grade reaction was observed,patients in control group start to administer medical radiation protective ointment until a month after radiation. Results The occurrence rate of acute breast dermal radiation reaction was 100%.Most patients in study group only underwent 1 grade radiation reaction （82%）,while 2 and 3 grade radiation reaction （47% and 13%） in control group were common （ P= 0. 000）. Both pruritic degree and pain degree were higher in control group compared with study group （both P= 0. 000）.In study group,the occurrence of 2 grade acute radiation-induced skin injury was obviously later than in control group with significant difference （P= 0. 000）.Patients observed with 3 grade reaction relieved to certain reaction after administering medical radiation protective ointment. Conclusions Medical radiation protective ointment can effectively both alleviate and delay acute radiation-induced skin injury compared with trolamine cream. It also has therapeutic effect on 3 grade radiation reaction.