局部晚期高危乳腺癌根治术后辅助低分割放疗的临床应用

Clinical Application of Postoperative Adjuvant Hypofractionated Radiotherapy for Locally Advanced High-risk Breast Cancer

目的:探索在局部晚期高危乳腺癌根治术后辅助放疗采用不同放疗分割方式对无进展生存期(PFS)的影响。方法:回顾性分析香港大学深圳医院2015年6月至2021年5月腋窝淋巴结阳性N3期、接受过乳房根治性切除术且接受术后辅助放疗的局部晚期高危乳腺癌患者的资料,患者的放疗分割方式采用低分割放疗及常规分割放疗,分析两种放疗方式对患者PFS的影响,用Kaplan-Meier法绘制患者生存曲线,并比较PFS差异;单因素和多因素Cox风险比例模型研究两种不同放疗分割方式对PFS的影响。结果:共纳入患者134例,患者中位年龄45岁,其中接受低分割放疗95例,接受常规分割放疗39例。中位随访时间为52个月,Cox回归分析显示:T分期是PFS的影响因素(P<0.05),放疗分割方式并非PFS的影响因素(P=0.160),矫正混杂因素T分期后,放疗分割方式亦非PFS的影响因素(P=0.069)。结论:局部晚期浸润性乳腺癌根治术后辅助放疗在本中心单一机构的临床实践中,低分割放疗与常规分割放疗疗效相似,患者PFS差异无统计学意义。低分割放疗能明显缩短患者的治疗周期,实现在有限的时间和设备资源条件下,为更多的患者提供服务。

Objective To investigate the effect of different radiotherapy fractionation methods on progression-free survival(PFS)after radical mastectomy for locally advanced high-risk breast cancer.Methods The data of patients with locally advanced high-risk breast cancer who received postoperative adjuvant radiotherapy in the University of Hong Kong-Shenzhen Hospital from June 2015 to May 2021 were retrospectively analyzed.Hypofractionated radiotherapy and conventional fractionated radiotherapy were used.The effects of the two radiotherapy modalities on PFS were analyzed.The survival curve of patients was calculated by Kaplan-Meier method,and the difference of PFS was compared.Univariate and multivariate Cox proportional hazard models were used to evaluate the effect of two different radiotherapy fractions on PFS.Results A total of 134 patients were included,with a median age of 45 years,of whom 95 received hypofractionated radiotherapy and 39 received conventional fractionated radiotherapy.Median follow-up was 52 months,and Cox regression analysis showed:T stage was an influential factor of PFS(P<0.05),but radiotherapy fractionation was not(P=0.160).After adjusting for the confounding factor of T stage,radiotherapy fractionation was not a factor influencing PFS(P=0.069).Conclusion In the clinical practice of adjuvant radiotherapy after radical mastectomy for locally advanced invasive breast cancer in a single institution in our center,the efficacy of hypofractionated radiotherapy was similar to that of conventional fractionated radiotherapy,and there was no statistical difference in PFS.Hypofractionated radiotherapy can significantly shorten the treatment cycle of patients and provide services for more patients under the condition of limited time and equipment resources.