早期乳腺癌保乳术后瘤床同步整合与瘤床后程补量IMRT研究

Comparison of clinical efficacy between simultaneous integrated boostintensity-modulated radiotherapy(SIB-IMRT)and late-course boost intensity-modulated radiotherapy(LB-IMRT)for early-stage breast cancer after breast-conserving surgery

目的比较早期乳腺癌保乳术后瘤床同步补量IMRT(SIB-IMRT)与瘤床后程补量IMRT(LB-IMRT)在放射损伤及疗效方面的差异性。方法选择2002-2012年间在山东省肿瘤医院行早期乳腺癌保乳术后IMRT的患者353例,其中218例接受SIB-IMRT,135例接受LB-IMRT。SIB-IMRT组处方剂量为瘤床(PTVt)2.15~2.3Gy 27~28次和乳腺(PTVb)1.8~1.9Gy,27~28次;LB-IMRT组处方剂量PTVb为2.0Gy 25次,后续PTVt补量2.0Gy,5~8次。结果中位随访期92个月。SIB-IMRT组与LB-IMRT组的美容效果优、良、一般、差者分别为10.1%、85.8%、3.7%、0.5%和12.6%、80.7%、5.2%、0.7%(P=0.731)。SIB-IMRT组和LB-IMRT组5年局部区域复发率(LRR)分别为3.21%和5.93%,10年LRR分别为4.13%和6.67%(P=0.209、0.280)。SIB-IMRT组和LB-IMRT组3、5、8、10年总生存率分别为97.7%、96.3%、94.9%、93.6%和97.8%、95.2%、92.0%、90.3%(P=0.288)。SIB-IMRT组和LB-IMRT组3、5、8、10年无瘤生存率分别为95.4%、91.8%、89.9%、89.0%和93.8%、87.7%、84.1%、82.1%(P=0.160)。结论保乳术后瘤床SIB-IMRT与LB-IMRT在美容效果、局控率、生存率等方面均相近,是安全可行的治疗方法。

Subject To compare the irradiation-induced injury and clinical efficacy between SIB-IMRT and LB-IMRT for early-stage breast cancer after breast-conserving surgery.Methods From November 2002 to February 2012,353 early breast cancer patients who underwent IMRT after breast-preserving surgery at Shandong Cancer Hospital were selected,of whom 218 patients receiving SIB-IMRT and 135 patients receiving LB-IMRT.The prescription dose of the SIB-IMRT group was the ipsilateral breast(PTVb)1.8-1.9 Gy,27-28 times,and concurrent tumor bed(PTVt)2.15-2.3 Gy,27-28 times.In the LB-IMRT group,the prescription dose was PTVb 2.0 Gy,25 times,followed by PTVt boost 2.0 Gy,5-8 times.Results The median follow-up time was 92 months.The excellent,good,fair,and poor cosmetic results in the SIB-IMRT and LB-IMRT groups were 10.1%and 12.6%,85.8%and 80.7%,3.7%and 5.2%,0.5%,and 0.7%,respectively(P=0.731).The 5-year locoregional recurrence rates(LRRs)in the SIB-IMRT and LB-IMRT groups were 3.21%and 5.93%and the 10-year LRRs were 4.13%and 6.67%,respectively(P=0.209,0.280).The 3-,5-,8-,and 10-year overall survival rate in the SIB-IMRT and LB-IMRT groups were 97.7%and 97.8%,96.3%and 95.2%,94.9%and 92.0%,93.6%and 90.3%,respectively(P=0.288).The 3-,5-,8-,and 10-year disease-free survival in the SIB-IMRT and LB-IMRT groups were 95.4%and 93.8%,91.8%and 87.7%,89.9%and 84.1%,89.0%and 82.1%,respectively(P=0.160).Conclusion There is no significant difference in the cosmetic effect,local control rate,and survival rate between SIB-IMRT and LB-IMRT after breast-preserving surgery in patients with early-stage breast cancer.SIB-IMRT is a safe and feasible treatment.