热疗加放疗治疗局部复发乳腺癌的疗效分析

Efficacy of local hyperthermia combined with external irradiation in treatment of regional recurrent breast carcinoma

目的 评价热疗加放疗治疗局部复发乳腺癌的疗效。方法 回顾性分析热疗加放疗治疗的85处病灶,其中39处病灶曾接受过放疗,未曾放疗的部位给予59.5±6.8 Gy(40-70Gy)照射,曾放疗的病灶实施43.0±12,4 Gy(12-74.4Gy)照射;热疗每周1次或1周2次,平均每例患者的热疗次数为4.5(2-9)次。结果 治疗1个月后CR率为92.0％,过去未曾放疗的病灶CR率为47.1％(16/34),曾放疗过病灶的CR率为56.1％(23/41),虽然曾放疗组的剂量(43.0±12.4 Gv)明显低于未放疗组的剂量(59.5±6.8 Gy),但两组间CR率差异无显著性(P=0.40)。治疗后4周时弥散/多发型病变较肿块/结节型病变的CR率高,而6个月后弥散/多发型的局部控制率却明显降低。结论 局部热疗配合放疗可以提高复发乳腺癌的局部控制率,特别是对曾经接受过放疗的区域可以降低放疗的剂量。弥散/多发型肿块较肿块/结节型的病灶对治疗的反应较早,但是很容易在短时期内复发。

Objective To evaluate the therapeutic efficacy of hyperthermia in combination with radiotherapy for regional recurrence of breast cancer. Methods Eighty-five lesions treated with local hyperthermia in combination with external irradiation were analysed retrospectively. Of the treated lesions,39 were previously irradiated. Mean radiation dose to previously un-irradiated area was 59.5 ?6.8 Gy(40-70 Gy), while a total dose of 43.0 ?12.4 Gy (12-74.4Gy) was given to previously irradiated tumors. Hyperthermia was administered once or twice a week. Average number of hyperthermia sessions was 4.5(2-9). Results The complete response rate(CR) was 90.0% one month after treatment.CR of 56.1%(23/41) for previously irradiated and 47.1%(16/34) for un-irradiated tumors were achieved respectively, with no significant difference between two groups although the radiation dose was significantly lower (43.0?12.4 Gy) for previously irradiated than that (59.5 ?6.8 Gy) for un-irradiat-ed. Comparing with the bulky/nodular tumor, the diffuse/multiple small nodular tumor showed higher CR rate 4 weeks after treatment, but it showed significantly lower local control rate 6 months after treatment. Conclusions Local control was improved when local hyperthermia combined with radiotherapy was administered in the treatment of locally recurrent breast cancer, especially the irradiation dose can be reduced for previously irradiated tumors. Diffuse/multiple small nodular tumors respond earlier than bulky/large nodular tumors. However, they tend to recur within the treatment fields.