乳腺癌保乳术后全乳大分割放疗序贯瘤床大分割补量的临床研究

Clinical study of fractionated whole-breast radiotherapy followed by fractionated tumor bed boost after breast-conserving surgery

目的比较乳腺癌保乳术后应用全乳大分割照射序贯瘤床大分割补量与常规放疗的安全性及近期疗效。方法将2020年3月—2022年10月在徐州医科大学附属医院行乳腺癌保乳术的96例女性患者纳入研究。按照分割模式分为常规组(conventional radiation therapy,CRT;全乳50Gy/25f序贯瘤床补量10Gy/5f)和大分割组(hypofractionation radiation therapy,HOFRT;全乳42.56Gy/16f序贯瘤床补量12.5Gy/5f)。比较2组患者乳腺相关的不良反应、其他放疗不良反应、1年肿瘤局部控制率及远处转移率。结果①CRT组和HOFRT组发生急性皮炎0~1级分别有42例(84.0%)和41例(89.1%),2~3级分别有8例(16.0%)和5例(10.9%),差异无统计学意义(P=0.463);2组患者发生乳腺水肿和疼痛各有4例和2例,差异无统计学意义(P=0.752);②CRT组和HOFRT组乳腺相关晚期不良反应中Ⅰ级乳腺组织皮下纤维化各有2例(4.0%,4.3%),差异无统计学意义(P=1.000);2组放疗后6个月、1年乳腺美容效果优良率分别为96.0%和94.0%、95.7%和93.4%,差异无统计学意义;③2组在3个月内各有2例患者发生无症状肺炎,但6个月内2组均未发生2级及以上放射性肺炎及放射性心脏损伤;④HOFRT组全程放疗时间约29 d,较CRT组40 d明显缩短;⑤随访期内2组均无患者发生照射野内复发,共有2例出现远处转移,CRT组1例骨转移,HOFRT组有1例肺转移。结论乳腺癌保乳术后全乳大分割序贯瘤床大分割补量放疗与常规分割放疗有着相似的不良反应及近期疗效,且明显缩短治疗时间,是一种安全、有效、短疗程的临床治疗方案,值得推广。

Objective To explore the safety and short-term effectiveness of hypofractionated whole-breast radiotherapy followed by fractionated tumor bed boost and conventional radiotherapy after breast-conserving surgery.Methods A total of 96 patients who underwent breast-conserving surgery in the Affiliated Hospital of Xuzhou Medical University from March 2020 to October 2022 were enrolled.According to fractionation schemes,they were divided into two groups:a conventional radiation therapy(CRT)group(whole-breast 50Gy/25f+tumor bed boost 10Gy/5f)and a hypofractionated radiotherapy(HOFRT)group(whole-breast 42.56Gy/16f+tumor bed boost 12.5Gy/5f)group.Both groups were compared for breast-related adverse reactions,other radiotherapy adverse reactions,1-year local control rate and distant metastasis rate.Results①There were 42 cases(84.0%)of grades 0-1 acute dermatitis in the CRT group and 41 cases(89.1%)in the HOFRT group,as well as 8 cases(16.0%)of grades 2-3 acute dermatitis in the CRT group and 5 cases(10.9%)in the HOFRT group,without statistical differences(P=0.463).There were 4 cases of breast edema and pain in the CRT group and 2 cases in the HOFRT group,without statistical differences(P=0.752).②For breast-related late adverse reactions,there were 2 cases(4.0%)of grade 1 subcutaneous tissue fibrosis in the CRT group and 2 cases(4.3%)in the HOFRT group,without statistical difference(P=1.000).The 6-month and 1-year good cosmetic outcome rates were 96.0%and 94.0%for the CRT group,and 95.7%and 93.4%for the HOFRT group,without statistical differences.③There were 2 cases of asymptomatic pneumonia in each group within three months,but no grade 2 or above radiation pneumonia and radiation heart injury occurred in both groups within six months.④The whole course of radiotherapy was about 29 days in the HOFRT group,which was significantly shorter than 40 days in the CRT group.⑤No recurrence occurred in the irradiation field in each group within the follow-up visit period.There were 2 cases of distant metastasis,including 1 case of bone metastasis in the CRT group and 1 case of lung metastasis in the HOFRT group.Conclusions Fractionated whole-breast radiotherapy followed by fractionated tumor bed boost after breast-conserving surgery has similar adverse reaction and short-term effectiveness with conventional fractionated radiotherapy,and obviously shortens the duration of treatment.It is a safe,effective and short-duration treatment scheme,and worthy of clinical application.