不同分割放射治疗模式对早期乳腺癌保乳术后患者免疫功能的影响

Effect of different fractionated radiotherapy modes on immune function of early breast cancer patients after breast conserving surgery

目的探讨不同分割放射治疗(放疗)模式对早期乳腺癌保乳术后患者免疫功能的影响。方法选取110例早期乳腺癌保乳术后患者,使用随机数表法分为观察组与对照组,每组55例。对照组患者接受常规分割的放疗模式,观察组患者接受短程大分割的放疗模式。比较两组患者危及器官(OAR)所受剂量、治疗前后免疫功能(淋巴细胞与单核细胞的比值)、急性放疗的不良反应发生率。结果观察组患者患侧肺接受5 Gy剂量照射的肺体积占全肺总体积的百分比(V5)、接受10 Gy剂量照射的肺体积占全肺总体积的百分比(V10)、接受20 Gy剂量照射的肺体积占全肺总体积的百分比(V20)、平均剂量以及健侧肺V5、V10、平均剂量分别为(54.25±10.54)%、(28.04±9.65)%、(15.04±4.65)%、(1008.65±165.57)cGy、(3.88±1.02)%、(0.15±0.02)%、(196.35±31.49)cGy,均低于对照组的(70.68±12.32)%、(35.68±9.61)%、(17.51±3.58)%、(1305.47±188.34)cGy、(7.65±2.02)%、(0.99±0.14)%、(239.65±85.47)cGy,差异具有统计学意义(P<0.05)。治疗前,观察组患者淋巴细胞与单核细胞的比值为(3.11±1.02),对照组为(3.36±1.20);治疗后,观察组患者淋巴细胞与单核细胞的比值为(1.92±0.34),对照组为(1.90±0.28)。治疗前,两组患者淋巴细胞与单核细胞的比值比较差异无统计学意义(P>0.05)。治疗后,两组患者淋巴细胞与单核细胞的比值均较治疗前降低,差异具有统计学意义(P<0.05)。治疗后,两组淋巴细胞与单核细胞的比值比较差异无统计学意义(P>0.05)。两组患者急性放疗的不良反应发生率比较差异无统计学意义(P>0.05)。结论对早期乳腺癌保乳术后患者进行短程大分割的放疗模式干预,不仅可以有效减少部分危及器官所受剂量水平,效果确切,还不会增加免疫抑制及放疗后不良反应风险,具有较高的安全性,值得推广应用。

Objective To explore the effect of different fractionated radiotherapy modes on immune function of early breast cancer patients after breast conserving surgery.Methods A total of 110 cases of early breast cancer patients after breast conserving surgery were divided into an observation group and a control group according to random numerical table,with 55 patients in each group.Patients in the control group received the conventional fractionation radiotherapy,while patients in the observation group received the short-range and large-division radiotherapy.Both groups of patients were compared in terms of the organ-at-risk(OAR)dose,immune function(ratio of lymphocytes to monocytes)before and after treatment,and the incidence of adverse reactions to acute radiotherapy.Results In the observation group,the percent volume receiving at least 5 Gy(V5),percent volume receiving at least 10 Gy(V10),percent volume receiving at least 20 Gy(V20),average dose of the affected lung,and V5,V10,average dose of the healthy lung were(54.25±10.54)%,(28.04±9.65)%,(15.04±4.65)%,(1008.65±165.57)cGy and(3.88±1.02)%,(0.15±0.02)%,(196.35±31.49)cGy,which were lower than(70.68±12.32)%,(35.68±9.61)%,(17.51±3.58)%,(1305.47±188.34)cGy and(7.65±2.02)%,(0.99±0.14)%,(239.65±85.47)cGy in the control group;the difference was statistically significant(P<0.05).Before treatment,the ratio of lymphocyte to monocyte was(3.11±1.02)in the observation group and(3.36±1.20)in the control group;after treatment,the ratio of lymphocytes to monocytes was(1.92±0.34)in the observation group and(1.90±0.28)in the control group.Before treatment,there was no significant difference in ratio of lymphocyte to monocyte between the two groups(P>0.05).After treatment,the ratio of lymphocytes to monocytes in both groups was lower than that before treatment,and the difference was statistically significant(P<0.05).After treatment,there was no significant difference in ratio of lymphocyte to monocyte between the two groups(P>0.05).There was no significant difference in the incidence of adverse reactions to acute radiotherapy between the two groups(P>0.05).Conclusion Short-range and large-division radiotherapy can effectively reduce the dose levels received by some organs at risk,but also does not increase the risk of immunosuppression and adverse reactions after radiotherapy,which has a high safety and is worthy of promotion and application.