早期乳腺癌保乳术后放化疗的最佳顺序

Sequencing of radiotherapy and chemotherapy after breast conservative surgery for early stage breast cancer

目的 探讨早期乳腺癌保乳治疗后放化疗最佳顺序 ,使保乳治疗的局部控制、远处转移和保乳效果达到最佳。方法 2 0 0 0年 1月～ 2 0 0 2年 11月 ,对 38例符合保乳治疗条件的早期乳腺癌实施了保乳治疗。手术方式为局部广泛切除术和腋窝淋巴结清扫 ,术后 2周开始化疗 ,化疗 2周期后再开始放疗 ,全乳剂量 5 0Gy ,瘤床补充照射 10～ 18Gy。放疗结束后根据使用化疗方案选择立即化疗或休息 1周后再开始化疗 ,化疗共 6周期。治疗结束后每 3个月复查 1次 ,放疗后 6个月行乳房钼靶摄影。此后 1年 1次乳房照片检查。结果 38例保乳治疗的患者均定期复查 ,中位随访 2 4个月 (5～ 35个月 )。未发现局部复发和远处转移。放疗后 1年或以上的 2 8例患者乳房外观良好。结论 早期乳腺癌保乳治疗中“三明治”式放化疗能满足保乳治疗的目的。

Objective To explore optimal procedure of radiotherapy and chemotherapy after conservative breast surgery for early stage breast cancer. Methods During January 2000 to November 2002, 38 eligible early stage breast cancer received breast conservative treatment in our hospital. Two weeks after lumpectomy and axillary lymph node dissection, chemotherapy was given two cycles before radiotherapy, radiotherapy total does 60-68Gy. Chemotherapy continued after radiotherapy until completing total plan. Results The median time of follow up was 24 months; neither local recurrence nor distant metastasis has been found. The patients who have finished the treatment for one year or more satisfy with cosmetic results. Conclusion For early stage breast cancer, radiotherapy and chemotherapy of Sandwich method are eligible.