左侧乳腺癌保乳术后两种不同化疗方案后序贯大分割放疗的心脏损伤临床研究

Heart injury in patients receiving hypofractionated radiotherapy with two chemotherapy regimens after left breast conserving surgery

目的观察左侧乳腺癌保乳术后两种化疗方案序贯大分割放疗对心脏损伤的情况。方法选择2018年1月—2020年4月收治的62例左侧乳腺癌保乳术后患者,随机分A组(ECT)和B组(TEC)两种化疗方案,每组31例,完成化疗后予以大分割放疗,放疗剂量为:全乳4005 cGy/15f,瘤床补量1000 cGy/5f;6个月后进行心电图(ECG)、肌钙蛋白(cTNI)、脑利那肽(BNP)、心肌酶谱、心脏彩超(UCG)检查,比较两组心脏损伤情况。结果①A组ECG异常率为9.68%(3例),B组ECG异常率为32.26%(10例),差异有统计学意义(P=0.029);②两组患者BNP值均在正常范围,但BNP参数的差异有统计学意义(P<0.05),余cTNI、乳酸脱氢酶(LDH)、天门冬氨酸氨基转移酶(AST)、肌酸激酶(CK)、肌酸激酶同工酶(CK-MB)差异无统计学意义(P>0.05);③两组患者化、放疗后UCG参数的差异无统计学意义(P>0.05)。结论EC-T化疗组较TEC化疗组后序贯大分割放疗具有降低心脏损伤的优势,可在临床上广泛使用。

Objective To observe the cardiac injury caused by two chemotherapy regimens with sequential hypofractionated radiotherapy after breast conserving surgery.Methods Totally 62 patients with left breast cancer treated in our Department from January 2018 to April 2020 were randomly divided into group A(EC-T)and group B(TEC)according to the chemotherapy regimens,31 in each group.All the patients received hyperfractionated radiotherapy after the chemotherapy treatment.The dose of radiotherapy was 4005 cGy/15f for the whole breast,and 1000 cGy/5f for tumor bed supplement.After 6 months,electrocardiogram(ECG),muscle calcium protein(cTNI),brain linatide(BNP),myocardial enzyme spectrum and cardiac ultrasound(UCG)tests were performed to compare the cardiac injury between the two groups.Results①There were 3(9.68%)abnormal ECGs in group A;and 10(32.26%)abnormal ECGs in group B(P=0.029).②The BNP values of the two groups were within the normal range,with significant difference in BNP parameters between the two groups(P<0.05).There was no difference in LDH,AST,CK,CK-MB between the two groups(P>0.05).③There was no significant difference in UCG parameters between the two groups(P>0.05).Conclusion Compared with the TEC chemotherapy group,the EC-T chemotherapy group with sequential hypofractionated radiotherapy can reduce cardiac injury,which can be widely used clinically.