乳腺癌术后行调强放疗与三维适形放疗的效果观察

Efficacy observation on intensity modulated radiation therapy and 3D conformal radiation therapy following surgery for breast cancer

目的探讨调强放疗(IMRT)与三维适形放疗(3D-CRT)在乳腺癌术后患者中的应用效果。方法选取解放军989中心医院2015年1月—2017年12月期间行保乳术治疗的乳腺癌患者92例,随机分为对照组、观察组,每组46例。两组均行乳腺癌保乳术及化疗,化疗2～3个疗程后,对照组行3D-CRT,观察组行IMRT,比较两组的照射剂量、放疗前后的基质金属蛋白酶-9(MMP-9)、基质金属蛋白酶组织抑制剂-1(TIMP-1)水平及不良反应发生情况。结果该研究92例患者均完成放疗,观察组左侧病灶及患侧肺脏照射剂量明显低于对照组(P<0.05);观察组PTV的V105%、V110%及V115%也均低于对照组(P<0.05);观察组CI高于对照组、HI低于对照组,差异有统计学意义(P<0.05);两组放疗后MMP-9水平均较本组放疗前降低,差异有统计学意义(P<0.05);放疗前、放疗后两组TIMP-1水平对比,差异无统计学意义(P>0.05);观察组皮肤反应、骨髓抑制、放射性肺损伤、胸骨后疼痛及消化障碍等不良反应发生率均低于对照组,差异有统计学意义(P<0.05)。结论 IMRT与3D-CRT相比,前者的PVT剂量均匀性及适形度均较好,危及器官的受照射剂量低,利于降低乳腺癌术后患者不良反应发生率。

Objective To investigate the application efficacy of intensity modulated radiation therapy (IMRT) and three dimensional conformal radiation therapy(3D-CRT) after surgery for breast cancer. Methods The 92 cases received breast-conserving surgery in 989 Central Hospital of PLA hospital from January 2015 to December 2017 were selected,and divided into control group and observation group,46 cases for each. Two groups were given breast-conserving surgery and chemotherapy. After chemotherapy of 2-3 courses,control group was given 3D-CRT,while observation group was given IMRT. The exposure dose,matrix metalloproteinase-9(MMP-9),tissue inhibitor of metalloproteinase-1(TIMP-1) before and after chemotherapy,adverse reactions were compared between the two groups. Results All the 92 patients were finished radiotherapy,the exposure dose of the left side of lesions and affected side of lungs in observation group was significantly lower than that in control group(P<0.05),the V105%,V110%,V115% of PTV in observation group were also did so(P<0.05);The CI of observation group was significantly higher than that of control group,while the HI of observation group was lower than that of control group(P<0.05);After radiotherapy,the MMP-9 levels of two groups decreased compared with those before radiotherapy (P<0.05);There was no statistical difference in the TIMP-1 levels between the two groups before and after radiotherapy(P >0.05);The incidence of adverse reactions such as skin reaction,bone marrow suppression,radiation-induced lung injury,retrosternal pain,digestive disorder in observation group was lower than that in control group(P<0.05). Conclusion Compared with 3D-CRT,IMRT has better uniformity and conformity of PVT dose,and the exposure dose of endangered organs is low,which is beneficial to decrease the incidence of adverse reactions in the patients with breast cancer undergoing surgery.