术中定向放疗推量照射在乳腺癌保乳术中临床应用研究

Targeted intraoperative radio therapy boost in breast conserving surgery for early breast cancer

目的研究乳腺癌保乳手术联合IntraBeam术中放疗系统进行术中靶向瘤床推量放射治疗的可行性、安全性、有效性及美容效果。方法共69例早期乳腺癌保乳手术患者接受了治疗,其中18.8%(13/69)患者年龄少于45岁,52.2%(36/69)肿物大于2 cm,40.6%(28/69)组织细胞学分级3级,29.0%(20/69)病人有淋巴结转移。病人保乳术后采用IntraBeam术中放疗系统瘤床表面20 Gy剂量进行术中靶向瘤床推量放射治疗,待化疗完成(或伤口愈合后)2周后给予传统全乳外照射放射疗治疗(50 Gy,共25次,省略瘤床推量照射),评估患者近期疗效及不良反应。结果总共27.5%(19/69)患者出现急性并发症,2.9%(2/69)患者出现血肿,8.7%(6/69)出现血清肿,7.2%(5/69)出现切口感染,8.7%(6/69)切口愈合延迟,切口中位愈合时间3.8(1.0~11)个月,中位随访24.8个月(12~51),2.9%(2/69)患者出现同侧乳房内复发,未出现远处转移及死亡病例,乳房美容效果评估优、良者术后1年占89.9%,术后2年占89.7%。结论乳腺癌保乳手术联合IntraBeam术中放疗系统进行术中靶向瘤床推量放射治疗近期疗效满意、不良反应较少,由于病人数量较少,随访时间较短,长远疗效仍需要进一步的验证。

Objective To investigate the safety and feasibility and Cosmetic outcomes of targeted intraoperative radio Therapy Boost with INTRABEAM in breast conserving surgery for early breast cancer.Methods We treated 69 unselected patients for early⁃stage breast cancer.Thirteen patients(13/69,18.8%)were younger than 45 years of age.More than half of the tumors(36/69,52.2%)were>2 cm.Twenty⁃eight(28/69,41.0%)had a Grade 3 tumor and,in twenty(20/69,29.0%)had axillary lymph nodes contained metastasis.After breast⁃conserving therapy,20 Gy was delivered intraoperatively to the surface of the tumor bed,followed by external⁃beam radiotherapy(EBRT),50 Gy,25 times in total,but excluding the usual boost.The early overall survival,recurrence⁃free survival,and non⁃metastatic survival and cosmetic outcomes were short⁃term follow⁃up.Results Acute complications were observed in 27.5%(19/69)of patients and included 2.9%(2/69)hematomas that required drainage,8.7%(6/69)seromas requiring drainage more than 3 times,7.2%(5/69)infections treated with antibiotics or surgery,8.7%(6/69)delayed wound healing and their average wound healing time was 3.8(1.0⁃11.0)months.There During a median follow⁃up of 24.8 months(12⁃51),2.9(2/69)of them developed local recurrence and there was no recurrence of distant metastasis or mortality.Cosmetic evaluation of breast in BCT with IORT group was carried out postoperative at points of one year and two years with 89.9%and 89.7%as excellent or fine cosmetic state respectively.Conclusion Targeted Intraoperative Radio Therapy Boost with INTRABEAM in breast conserving surgery for early⁃stage breast cancer is both safe and reliable,the long⁃term efficacy still needs to be further verified because of the small number of patients and short follow⁃up time.