早期乳腺癌保乳术后全乳大分割照射同步瘤床加量与常规分割放疗的效果对比

Comparison of the effect be hypofractionated -simultaneous integrated boost-intensity modulated radiotherapy and conventional radiotherapy in early-stage breast cancer after breast conserving surgery

目的比较对早期乳腺癌患者保留乳房手术后行全乳大分割照射并瘤床区同步加量调强放疗(简称HF-SIB-IMRT)与常规分割放疗方案的临床效果及安全性。方法 2015年8月-2017年8月在浙江省肿瘤医院共纳入60例早期浸润性导管乳腺腺癌(T1~T2N0M0期)行保乳术患者。根据随机数字表法将其分为HF-SIB-IMRT组(30例)和常规放疗组(30例)。术后放疗方案:HF-SIB-IMRT组为全乳腺照射同步行瘤床区推量照射,总疗程24 d。常规放疗组为全乳腺照射后序贯瘤床区局部加量照射,总疗程44 d。比较2组的局部控制率,美容效果,放疗相关毒副反应发生率及复发率。结果随访1.5年,2组均无复发及死亡病例,局部控制率和1年生存率均为100%。HF-SIB-IMRT组和常规放疗组放疗结束后1个月、6个月美容效果优良率比较差异均无统计学意义(均P>0.05);2组≤2级急性不良反应、晚期皮肤/皮下组织的不良反应,中性粒细胞、血小板减少等血液毒性不良反应发生率比较,差异均无统计学意义(均P>0.05)。结论对早期乳腺癌患者保乳术后行全乳大分割照射并瘤床区同步加量放疗,可获得较为满意的近期疗效,并不增加放疗毒副反应,可缩短术后放疗总疗程时间是其临床优势。

Objective To compare the clinical efficacy and safety of hypofractionated-simultaneous integrated boost-intensity modulated radiotherapy(HF-SIB-IMRT) and conventional radiotherapy for early-stage breast cancer patients after breast-conserving surgery. Methods From August 2015 to August 2017, 60 patients with early-stage invasive ductal breast cancer(cT1-T2N0M0 staging) underwent breast conserving surgery in a hospital were enrolled. According to the random number table method, they were divided into HF-SIB-IMRT group(30 cases) and conventional radiotherapy group(30 cases). After operation, the HF-SIB-IMRT group received total breast irradiation for 15 times, and simultaneous integrated boost of tumor bed for 24 days. The routine radiotherapy group received 25 fractions of total breast irradiation followed by sequential irradiation, and local total irradiation 60.0 Gy in the tumor bed. The total course of treatment was 44 days. The local control rate, cosmetic effect, incidence of radiation-related side effects and recurrence rate were compared between the two groups. Results Both groups were followed up for at least 1.5 years. During the follow-up period, there was no recurrence in both groups. The local control rate was 100% and the one-year survival rate was 100%. There was no significant difference in cosmetic effect between HF-SIB-IMRT group and conventional radiotherapy group at the end of 1 month,6 months(all P>0.05). There was no significant difference between HF-SIB-IMRT group and routine radiotherapy group in the incidence of acute adverse events(<grade 2), late skin/subcutaneous adverse events, hematotoxic adverse events such as neutropenia and thrombocytopenia(all P>0.05). Conclusion Whole breast hypofractionated intensity modulated radiotherapy with simultaneous integrated boost of tumor bed after breast conserving surgery for early breast cancer patients can obtain satisfactory short-term curative effect, without increasing the toxicity and side effects of radiotherapy, and can shorten the total course of radiotherapy after breast conserving surgery, which is its clinical advantage.