皮肤填充物联合局部热疗在乳腺癌改良根治术后放疗中的效果探讨

Effect of dermal fillers combined with local hyperthermia in radiotherapy after modified radical mastectomy for breast cancer patients

目的探究皮肤填充物联合局部热疗在乳腺癌患者改良根治术后放疗中的应用效果。方法 192例行乳腺癌改良根治术的乳腺癌患者,根据治疗方案不同分为对照组和观察组,各96例。两组患者术后均行放疗及局部热疗,对照组患者放疗时不使用皮肤填充物,观察组患者放疗时使用皮肤填充物。对比两组患者治疗前后炎症因子和肿瘤标记物水平,靶区平均剂量(Dmean)与均匀性指数(HI),不良反应发生情况和复发转移情况、生存情况。结果治疗后,两组白细胞介素(IL)-2、IL-4、肿瘤坏死因子(TNF-α)水平均高于治疗前,癌胚抗原(CEA)、甲胎蛋白(AFP)、糖类抗原15-3(CA15-3)水平均低于治疗前,差异有统计学意义(P<0.05);治疗后,观察组TNF-α水平高于对照组, CEA、AFP、CA15-3水平低于对照组,差异具有统计学意义(P<0.05)。观察组靶区平均剂量(47.5±0.04)Gy高于对照组的(41.3±0.03)Gy,均匀性指数(1.16±0.15)低于对照组的(1.32±0.21),差异具有统计学意义(P<0.05)。两组放射性肺损伤、放射性皮肤损伤及放射性心脏损伤发生率比较,差异均无统计学意义(P>0.05)。随访期间,观察组胸壁局部复发率及远处转移率均显著低于对照组,差异有统计学意义(P<0.05),两组区域复发率比较,差异无统计学意义(P>0.05)。对照组死亡率为22.92%(22/96),平均生存期为(28.59±0.73)个月;观察组死亡率为10.42%(10/96),平均生存期为(38.38±0.76)个月;观察组死亡率明显低于对照组,平均生存期长于对照组,差异有统计学意义(χ^2/t=5.097、91.025, P<0.05)。结论皮肤填充物联合局部热疗在乳腺癌患者改良根治术后放疗中具有较好的疗效,靶区平均剂量高,分布更加均匀,可有效改善炎症因子和肿瘤标记物水平,长期随访复发转移率和死亡率低,值得临床推广。

Objective To investigate the practical effect of dermal fillers combined with local hyperthermia in radiotherapy after modified radical mastectomy for breast cancer patients. Methods A total of 192 cases of breast cancer patients after modified radical mastectomy were divided into control group and observation group according to different treatment regimens, with 96 cases in each group. Both groups received radiotherapy and local hyperthermia after surgery. The control group did not use dermal fillers during radiotherapy, and the observation group received dermal fillers during radiotherapy. The levels of inflammatory factors and tumor markers before and after treatment, mean target dose(Dmean) and heterogeneous index(HI), occurrence of adverse reactions, recurrence and metastasis, and survival of the two groups were compared. Results After treatment, the levels of interleukin(IL)-2, IL-4, and tumor necrosis factor-α(TNF-α) of the two groups were higher than those before treatment, and carcinoembryonic antigen(CEA), alpha-fetoprotein(AFP), carbohydrate antigen 15-3(CA15-3) level was lower than before treatment, and the difference was statistically significant(P<0.05). After treatment, TNF-α of the observation group was higher than that of the control group, and CEA, AFP and CA15-3 were lower than those of the control group, and the difference was statistically significant(P<0.05). The mean target dose(47.5±0.04) Gy of the observation group was higher than(41.3±0.03) Gy of the control group, and the heterogeneous index(1.16±0.15) was lower than(1.32±0.21) of the control group, and the difference was statistically significant(P<0.05). There was no statistically significant difference in the incidence of radiation-induced lung injury, radiation-induced skin injury, and radiation-induced heart injury between the two groups(P>0.05). During the follow-up period, the local recurrence rate and distant metastasis rate of the observation group were significantly lower than those of the control group, and the difference was statistically significant(P<0.05), but there was no significant difference in the regional recurrence rate between the two groups(P>0.05). The mortality rate in the control group was 22.92%(22/96), and the average survival period was(28.59± 0.73) months;the mortality rate in the observation group was 10.42%(10/96), and the average survival period was(38.38±0.76) months;the mortality rate in the observation group was obviously lower than that of the control group, and average survival period was longer than that of the control group, and the difference was statistically significant(χ^2/t=5.097, 91.025, P<0.05). Conclusion The use of dermal fillers combined with local hyperthermia have good anti-tumor effectiveness with the low recurrence and metastasis rate and mortality during the long-term follow-up, which can effectively improve the levels of inflammatory factors and tumor biomarkers in breast cancer patients after modified radical mastectomy and is worthy of clinical promotion.