转移性三阴性乳腺癌化疗后放疗的疗效研究

Efficacy of radiotherapy after chemotherapy for metastatic triple-negative breast cancer

目的探讨化疗后原发灶和区域转移淋巴结放疗对转移性三阴性乳腺癌(TNBC)疗效的影响。方法回顾性分析本院2012年5月至2015年12月资料完整的50例转移性TNBC患者的临床资料,其中对照组25例仅接受系统化疗,观察组25例在系统化疗后接受乳腺原发灶和区域转移淋巴结IMRT放疗,GTV 6000cGy/25f/5W,GTVnd 6000cGy/25f/5W,PTV 5000cGy/25f/5W,局部电子线补量照射1000~1600 cGy/5~8f,对比分析患者的疗效和不良反应。结果观察组和对照组化疗疗效比较,差异无统计学意义(P>0.05)。原发灶放疗的CR达48%,PR为52%,ORR为100%;区域转移淋巴结放疗的CR达56%,PR为44%,ORR为100%。mLFFS观察组为16个月(8~40个月),对照组为11个月(4~20个月),具有统计学差异(P=0.003);mOS观察组为17个月(8~48个月),对照组为13个月(6~26个月),具有统计学差异(P=0.019)。无严重毒副作用发生。结论化疗后放疗可改善转移性TNBC患者的预后。

Objective To investigate the effect of radiotherapy for primary lesions and regional metastatic lymph nodes after chemotherapy on the outcome of patients with metastatic triple-negative breast cancer(TNBC).Methods A retrospective analysis was performed on the whole clinical data of 50 patients with metastatic TNBC who were admitted to our hospital from May 2012 to December 2015.Among them,25 patients in the control group received systemic chemotherapy alone and the other 25 patients in the observation group received intensity-modulat⁃ed radiation therapy for the primary lesions and regional metastatic lymph nodes after systemic chemotherapy,with gross tumor volume of 6000 cGy/25 f/5 w,gross tumor volume of nodes of 6000 cGy/25 f/5 w,planning tumor volume of 5000 cGy/25 f/5 w,and local electron-beam boost irradiation of 1000-1600 cGy/5-8 f.A comparative analysis was performed on the outcomes and adverse reactions of patients.Results There was no significant difference in the efficacy of chemotherapy between the observation group and the control group(P>0.05).The primary lesions had a complete response(CR)rate of 48%,a partial response(PR)rate of 52%,and an overall response rate(ORR)of 100%,and the regional metastatic lymph nodes had CR,PR,and OR rates of 56%,44%,and 100%,respectively.The observation group and control group had median locoregional failure-free survival time of 16 months(8 to 40 months)and 11 months(4 to 20 months),respectively,with a significant difference between the two groups(P=0.003).The observation group and control group had median overall survival time of 17 months(8 to 48 months)and 13 months(6 to 26 months),respectively,with a significant difference between the two groups(P=0.019).No serious toxicity and side effects were found.Conclusion Radiotherapy after chemotherapy can improve the progno⁃sis of patients with metastatic TNBC.