右乳腺癌术后内乳放疗效果及安全性的研究

Efficacy and safety of postoperative irradiation of internal mammary chain for right breast cancer

目的 探讨右侧乳腺癌改良根治术后腋窝淋巴结转移≥4枚患者行内乳电子线放射照射的近期疗效及放射性肺炎的风险因素研究。方法 选择行右侧乳腺癌改良根治术,且腋窝淋巴结转移≥4枚患者100例,其中N2期66例,N3期34例。所有患者接受规范的新辅助或术后辅助化疗、靶向及内分泌治疗。放疗方案右侧锁骨上下区采用调强X线放疗,右侧胸壁野及右侧内乳区采用电子线,放疗剂量均为50 Gy/25次。观察患者近期疗效及放射性肺炎的发生情况,进一步探索放射性肺炎发生的高危因素。结果 患者清扫腋窝淋巴结的中位数为22枚,而淋巴结阳性的中位数为7枚。中位随访39.5个月,区域淋巴结复发1例,胸壁复发2例,远处转移4例,死亡1例。1级放射性肺炎38例(38%),2级放射性肺炎2例(2%)。Logistic分析显示,放疗后2级淋巴细胞降低是导致放射性肺炎的独立因素。结论 右侧乳腺癌改良根治术后行内乳区电子线放疗安全可行,并未额外增加不良反应。放疗后发生2级及以上淋巴细胞降低是发生放射性肺炎的高危因素。

Objective To explore the short-term efficacy of electron beam irradiation of internal mammary chain(IMC)and the risk factors of radiation pneumonia in patients with axillary lymph node metastasis≥4 after modified radical mastectomy for right breast cancer.Methods In total,100 patients with right breast cancer and axillary lymph node metastasis≥4 were selected for modified radical mastectomy,including 66 patients with N2 stage and 34 patients with N3 stage.All patients receive standardized neoadjuvant or postoperative adjuvant chemotherapy,targeted and endocrine therapy.The radiation therapy plan involved intensity modulated radiation therapy(IMRT)in the upper and lower areas of the right clavicle,and electronic wires were used in the right chest wall field and right inner breast area.The radiation dose was 50 Gy/25 times.The short-term efficacy and incidence of radiation pneumonia in these patients were observed,and the high-risk factors for the occurrence of radiation pneumonia were further explored.Results The median number of axillary lymph node dissection in the patients was 22,while the median number of lymph node positivity was 7.During a median follow-up of 39.5 months,there was 1 patient with regional lymph node recurrence,2 patients with chest wall recurrence,4 patients with distant metastasis,and 1 patient with death.There were 38 patients(38%)with grade 1 radiation pneumonia and 2 patients(2%)with grade 2 radiation pneumonia.Logistic analysis showed that grade 2 lymphocyte depletion after radiotherapy was an independent factor leading to radiation pneumonia.Conclusion It is safe and feasible to use electron beam irradiation of IMC after modified radical mastectomy for right breast cancer without additional adverse reactions.The occurrence of grade 2 or above lymphocyte depletion after radiotherapy is a high-risk factor for the development of radiation pneumonia.