混合调强放疗对局部晚期乳腺癌手术患者免疫功能的影响及疗效观察

Effect of hybrid intensity modulated radiotherapy on the immune function of patients with locally advanced breast cancer surgery and efficacy observation

目的:探讨混合调强放疗(Hy-IMRT)对局部晚期乳腺癌改良根治术后患者免疫功能的影响及疗效。方法:选取2015年1月至2017年1月就诊于江苏省常州市肿瘤医院的94例曾接受乳腺癌改良根治术且需要术后放疗的局部晚期乳腺癌患者,按随机数字表法将患者分为Hy-IMRT组(观察组)47例和三维适形放疗(3DCRT)组(对照组)47例。观察并比较两组患者各自靶区的剂量及相关放射物理学参数、放疗期间及放疗后不良反应、放疗前后细胞因子及T细胞亚群、3年局部复发率、远处转移率及死亡率。结果:观察组95%的靶体积所得到的剂量(D 95%)[(4 945.6±36.1)Gy比(4 754.0±35.6)Gy]、靶区适形度(CI)(0.7±0.1比0.5±0.1)高于对照组,差异均有统计学意义(均 P<0.05);观察组的大于110%处方剂量的靶体积(V 110%)[(1.6±0.5)cm 3比(8.4±1.2)cm 3]、大于105%处方剂量的靶体积(V 105%)[(19.3±3.5)cm 3比(26.6±5.6)cm 3]、不均匀性指数(HI)(1.1±0.1比1.3±0.1)均小于对照组,差异均有统计学意义(均 P<0.05)。观察组急性皮肤不良反应发生率[53.2%(25/47)比74.5%(35/47)]、骨髓抑制发生率[40.4%(19/47)比70.2%(33/47)]低于对照组,差异均有统计学意义(均 P<0.05)。放疗前两组白细胞介素6(IL-6)、肿瘤坏死因子α(TNF-α)、CD4 +、CD8 +、CD4 +/CD8 +水平差异均无统计学意义(均 P>0.05),放疗结束时,两组IL-6、TNF-α、CD8 +水平均较放疗前增高(均 P<0.05),CD4 +、CD4 +/CD8 +水平均较放疗前降低(均 P<0.05);放疗结束时,观察组IL-6、TNF-α、CD8 +水平低于对照组,CD4 +、CD4 +/CD8 +水平高于对照组,差异均有统计学意义(均 P<0.05)。观察组的3年局部复发率[34.04%(16/47)比42.55%(20/47)]、远处转移率[25.53%(12/47)比38.30%(18/47)]及死亡率[14.89%(7/47)比19.15%(9/47)]均低于对照组,但差异均无统计学意义(均 P>0.05)。 结论:相比3DCRT,Hy-IMRT对改良根治术后局部晚期乳腺癌患者免疫功能影响较小,且急性皮肤不良反应、骨髓不良反应发生率低。

Objective To investigate the effect of hybrid intensity modulated radiotherapy(Hy-IMRT)on immune function in patients with locally advanced breast cancer surgery and the treatment efficacy.Methods A total of 94 patients with locally advanced breast cancer who underwent modified radical mastectomy for breast cancer and required postoperative radiotherapy in Changzhou Cancer Hospital in Jiangsu Province from January 2015 to January 2017 were selected.The patients were divided into Hy-IMRT group(observation group,47 cases)and three-dimensional conformal radiotherapy(3DCRT)group(control group,47 cases)according to the random number table method.The dose and related radiophysical parameters of the respective target areas of the two groups,adverse reactions during and after radiotherapy,cytokines and T lymphocyte subsets before and after radiotherapy,3-year local recurrence rate,distant metastasis rate and mortality were observed and compared between the two groups.Results The dose obtained by 95%(D95%)[(4945.6±36.1)Gy vs.(4754.0±35.6)Gy]and target area conformity(CI)of the target volume(0.7±0.1 vs.0.5±0.1)in the observation group were greater than those in the control group,and the differences were statistically significant(both P<0.05);the target volume of 110%of the prescription dose(V110%)[(1.6±0.5)cm3 vs.(8.4±1.2)cm3],the target volume of more than 105%of the prescription dose(V105%)[(19.3±3.5)cm3 vs.(26.6±5.6)cm3]and the heterogeneity index(HI)(1.1±0.1 vs.1.3±0.1)in the observation group were all smaller than those of the control group,and the differences were statistically significant(all P<0.05).The incidence of acute skin adverse reactions[53.2%(25/47)vs.74.5%(35/47)]and the incidence of bone marrow suppression[40.4%(19/47)vs.70.2%(33/47)]in the observation group were lower than those in the control group,and the differences were statistically significant(both P<0.05).There were no significant differences in levels of interleukin 6(IL-6),tumor necrosis factor alpha(TNF-α),CD4+,CD8+,and CD4+/CD8+between the two groups before radiotherapy(all P>0.05).At the end of radiotherapy,the levels of IL-6,TNF-αand CD8+were higher in both groups than before radiotherapy(all P<0.05),and CD4+and CD4+/CD8+were lower than before radiotherapy(both P<0.05).The levels of IL-6,TNF-αand CD8+in the observation group were lower than those in the control group,while the CD4+and CD4+/CD8+were higher than those in the control group(all P<0.05).The 3-year local recurrence rate[34.04%(16/47)vs.42.55%(20/47)],distant metastasis rate[25.53%(12/47)vs.38.30%(18/47)]and mortality rate[14.89%(7/47)vs.19.15%(9/47)]in the observation group were lower than those in the control group,but the differences were not statistically significant(all P>0.05).Conclusion Compared with 3DCRT,the Hy-IMRT has less effect on the immune function of locally advanced breast cancer patients after modified radical resection,and the incidences of acute skin reaction and bone marrow adverse reaction are low.