Background- To compare two types of therapy for primary breast carcinoma, breast-conserving therapy （BCT） and modified radical mastectomy （MRM）, in a matched cohort study. Methods： A series of 1,746 patients with...Background- To compare two types of therapy for primary breast carcinoma, breast-conserving therapy （BCT） and modified radical mastectomy （MRM）, in a matched cohort study. Methods： A series of 1,746 patients with primary breast cancer treated with BCT or MRM in a single Chinese institute between January 2000 and February 2009 were analyzed retrospectively to compare their outcomes with respect to the incidence of local recurrence （LR）, distant metastasis, and survival. The patients were matched with regard to age at diagnosis, spreading to axillary lymph nodes, hormone receptor status, the use of neoadjuvant chemotherapy and maximal tumor diameter. The match ratio was 1：1, and each arm included 873 patients. Results： The median follow-up period was 71 months. The 6-year disease-free survival （DFS） and 6-year distant disease-free survival （DDFS） rates differed significantly between two groups. The 6-year local recurrence-free survival （LRFS） rates were 98.2% [95% confidence interval （CI）： 0.973-0.989] in the BCT group and 98.7% （95% CI： 0.980-0.994） in the MRM group （P=0.182）, respectively. DFS rates in BCT and MRM groups were 91.3% （95% CI： 0.894-0.932） and 86.3% （95% CI： 0.840-0.886） （P〈0.001）, respectively, whereas the DDFS rates in BCT and MRM groups were 93.6% （95% CI： 0.922-0.950） and 87.7% （95% CI： 0.854-0.900） （P〈0.001）, respectively. Conclusions： BCT in eligible patients is as effective as MRM with respect to local tumor control, DFS and DDFS, and may result in a better outcome than MRM in Chinese primary breast cancer patients.展开更多
We investigated the factors predicting radiation-induced organizing pneumonia (RIOP) relapse after tangential breast irradiation. The participants included 23 patients diagnosed with RIOP at the St. Marianna Universit...We investigated the factors predicting radiation-induced organizing pneumonia (RIOP) relapse after tangential breast irradiation. The participants included 23 patients diagnosed with RIOP at the St. Marianna University School of Medicine Hospital between January 2008 and March 2015. Relapse was defined as the appearance of new lesions on diagnostic images during follow-up or after commencing treatment. The relapse-free survival rate and the following 9 parameters were compared between patients with and without RIOP relapse: 1) age (less than vs. equal to or more than the median);2) white blood cell count (less than vs. equal to or more than the median);3) C-reactive protein (CRP) level at the time of RIOP diagnosis (less than normal, more than normal/ less than borderline, and more than borderline);4) boost irradiation (yes vs. no);5) maximum lung depth on linacgraphy (less than vs. equal to or more than the median);6) hormone therapy (yes vs. no);7) chemotherapy (yes vs. no);8) RIOP ratio in the whole lung (less than vs. equal to or more than the median) at the time of RIOP diagnosis;and 9) use of corticosteroids (yes vs. no). The Kaplan-Meier method was used for statistical analysis, with relapse as the cutoff. The follow-up period spanned the date of RIOP onset to May 30, 2015. The level of significance for 2-sided tests was p < 0.05. Relapse was evident in 14 patients (60.8%). The relapse-free survival rate was significantly greater in the normal CRP group (less than 0.30 mg/dl) than in the abnormal CRP group (more than 0.36 mg/dl) (p = 0.044) and in the normal/borderline CRP group (less than 0.36 mg/dl) than in the high CRP group (more than 0.70 mg/dl) (p < 0.01). The CRP level at RIOP onset may be a useful predictor of relapse after breast-conserving therapy.We investigated the factors predicting radiation-induced organizing pneumonia (RIOP) relapse after tangential breast irradiation. The participants included 23 patients diagnosed with RIOP at the St. Marianna University School of Medicine Hospital between January 2008 and March 2015. Relapse was defined as the appearance of new lesions on diagnostic images during follow-up or after commencing treatment. The relapse-free survival rate and the following 9 parameters were compared between patients with and without RIOP relapse: 1) age (less than vs. equal to or more than the median);2) white blood cell count (less than vs. equal to or more than the median);3) C-reactive protein (CRP) level at the time of RIOP diagnosis (less than normal, more than normal/ less than borderline, and more than borderline);4) boost irradiation (yes vs. no);5) maximum lung depth on linacgraphy (less than vs. equal to or more than the median);6) hormone therapy (yes vs. no);7) chemotherapy (yes vs. no);8) RIOP ratio in the whole lung (less than vs. equal to or more than the median) at the time of RIOP diagnosis;and 9) use of corticosteroids (yes vs. no). The Kaplan-Meier method was used for statistical analysis, with relapse as the cutoff. The follow-up period spanned the date of RIOP onset to May 30, 2015. The level of significance for 2-sided tests was p < 0.05. Relapse was evident in 14 patients (60.8%). The relapse-free survival rate was significantly greater in the normal CRP group (less than 0.30 mg/dl) than in the abnormal CRP group (more than 0.36 mg/dl) (p = 0.044) and in the normal/borderline CRP group (less than 0.36 mg/dl) than in the high CRP group (more than 0.70 mg/dl) (p < 0.01). The CRP level at RIOP onset may be a useful predictor of relapse after breast-conserving therapy.展开更多
Objective: To investigate the effect of breast-conservation therapy in early stage breast cancer. Methods: A total of 234 early stage breast carcinoma patients received breast conserving treatment in our hospital. Aft...Objective: To investigate the effect of breast-conservation therapy in early stage breast cancer. Methods: A total of 234 early stage breast carcinoma patients received breast conserving treatment in our hospital. After the operation, they underwent adjuvant chemotherapy and radiotherapy. All of these patients desired to preserve their breasts. Results: After median follow-up of 29.46 months (range from 3 to 100 months), 3 cases had local relapse and 8 cases had distant metastasis. The overall survival rate of 5 year was 96.7%, and the disease free survival rate of 5 year was 87.85%. Conclusion: For early stage breast carcinoma patients, classic quadrantectomy, axillary dissection and post-operative adjuvant chemotherapy and radiotherapy lead to excellent local control and good survival.展开更多
Purpose: To evaluate long-term skin reactions following breast-conserving therapy by using the melanin-erythema index meter. Patients and Methods: 164 patients were followed for at least three years after breast-conse...Purpose: To evaluate long-term skin reactions following breast-conserving therapy by using the melanin-erythema index meter. Patients and Methods: 164 patients were followed for at least three years after breast-conserving therapy. For both the erythema and the melanin indices, the ratio of the irradiated-side index to the non-irradiated-side index was calculated. The time course of index ratios alternation was examined. Influences from additional therapies and patients’ age were also evaluated. Result: Both erythema and melanin index ratios of the breast skin were recovered to pre-radiation level three years after radiotherapy. However, both index ratios of the area administrated with 10-Gy boost irradiation were still high even after five years after radiotherapy. Endocrine therapy, chemotherapy and age had no significant influence on skin color reactions three years after radiotherapy. Conclusion: Quantitative assessment using the melanin-erythema index meter demonstrated that chronic skin reactions following breast conserving therapy had recovered to pre-radiation level for three years after irradiation except for the 10-Gy boost irradiated area.展开更多
Objective: The present study examined the effect of radiotherapy on recurrence and survival in elderly patients with hormone receptor-positive early breast cancer.Methods: A retrospective analysis of 327 patients aged...Objective: The present study examined the effect of radiotherapy on recurrence and survival in elderly patients with hormone receptor-positive early breast cancer.Methods: A retrospective analysis of 327 patients aged ≥65 years, with stage I-II, hormone receptor-positive breast cancer who underwent breast-conserving surgery and received endocrine therapy(ET) or radiotherapy plus endocrine therapy(ET+RT) was performed. Both groups were divided into luminal A type and luminal B type subgroups. Evaluation criteria were 5-year disease-free survival(DFS), local relapse rate(LRR), overall survival(OS), and distant metastasis rate(DMR).Results: There were significant differences in 5-year DFS [hazard ratio(HR)=1.59, 95% confidence interval(95% CI), 1.15-2.19;P=0.005] and LRR(HR=3.33, 95% CI, 1.51-7.34;P=0.003), whereas there were no significant differences in OS and DMR between ET group and ET+RT group. In luminal A type, there was no significant difference in 5-year DFS, LRR, OS and DMR between ET group and ET+RT group. In luminal B type,there were statistically significant differences in 5-year DFS(HR=2.19, 95% CI, 1.37-3.49;P=0.001), LRR(HR=5.45, 95% CI, 1.65-17.98;P=0.005), and OS(HR=1.75, 95% CI, 1.01-3.05;P=0.048) between ET group and ET+RT group. In the ET group, there were significant differences between luminal A type and luminal B type in5-year DFS(HR=1.84, 95% CI, 1.23-2.75;P=0.003) and OS(HR=1.76, 95% CI, 1.07-2.91;P=0.026).Conclusions: After breast-conserving surgery, radiotherapy can reduce the LRR and improve the DFS and OS of luminal B type elderly patients, whereas luminal A type elderly patients do not benefit from radiotherapy.Without radiotherapy, luminal A type patients have better DFS and OS than luminal B type patients.展开更多
Objective The aim of this study was to evaluate the efficacy, complications and cosmetic results of three-dimensional conformal radiation therapy for early breast cancer after conservative surgery.
Mammographic appearance of the normal breast is altered in the post-operative setting. It is essential to be aware of the normal findings as well as to identify features of recurrent disease with particular emphasis o...Mammographic appearance of the normal breast is altered in the post-operative setting. It is essential to be aware of the normal findings as well as to identify features of recurrent disease with particular emphasis on radiologicalpathological concordance. Digital breast tomosynthesis and volumetric breast density add incremental value in this clinical setting. We present a pictorial review of various cases to illustrate normal post-operative findings as well as mammographic features suspicious for recurrent disease.展开更多
影像学技术的进步使得越来越多的多灶性/多中心性乳腺癌(multifocal/multicentric breast cancer, MMBC)在早期被发现。传统观念认为,MMBC比单灶性乳腺癌(unifocal breast cancer, UBC)预后更差,应积极升级治疗手段。近年来,随着医疗水...影像学技术的进步使得越来越多的多灶性/多中心性乳腺癌(multifocal/multicentric breast cancer, MMBC)在早期被发现。传统观念认为,MMBC比单灶性乳腺癌(unifocal breast cancer, UBC)预后更差,应积极升级治疗手段。近年来,随着医疗水平的提升,MMBC患者的诊断、个体化治疗、接受保乳手术的安全性等焦点问题需重新被审视。本文将从MMBC流行病学特征、术前影像学评估、病理异质性与分子标志物、手术方式等多方面展开论述,以期加深临床认知。展开更多
目的探究在Halcyon直线加速器上使用调强适形放射治疗(IMRT)和容积旋转调强放射治疗(VMAT)进行乳腺癌保乳术后放射治疗的临床应用。方法选择乳腺癌保乳术后放射治疗患者25例,年龄36~61岁,平均年龄50.9岁;左侧乳腺癌15例,右侧乳腺癌10例...目的探究在Halcyon直线加速器上使用调强适形放射治疗(IMRT)和容积旋转调强放射治疗(VMAT)进行乳腺癌保乳术后放射治疗的临床应用。方法选择乳腺癌保乳术后放射治疗患者25例,年龄36~61岁,平均年龄50.9岁;左侧乳腺癌15例,右侧乳腺癌10例;肿瘤分期均为T1~T2、N0、M0。计划设计均在Eclipse计划系统上,每例患者分别采用IMRT和VMAT进行计划设计。对两类计划的主要剂量学参数、剂量分布、γ通过率和照射时间进行比较。结果所有计划均可临床使用,两组计划靶区D_(95%)、平均剂量D_(mean)差异较小(P>0.05),靶区均匀性指数(HI)(IMRT组0.06±0.01 vs VMAT组0.06±0.01),差异无统计学意义(P>0.05),适形性指数(CI)(IMRT组0.85±0.03 vs VMAT组0.92±0.02),差异有统计学意义(P<0.05)。IMRT组患侧肺V_(5)、V_(20)和平均剂量,心脏平均剂量,健侧肺V_(5)均低于VMAT组,差异具有统计学意义[患侧肺V_(5)(41.36±2.04)%vs(47.58±2.42)%、患侧肺V_(20)(15.04±2.90)%vs(16.35±1.97)%、患侧肺平均剂量(886.32±79.41)cGy vs(993.49±50.14)cGy、心脏平均剂量(209.23±98.12)cGy vs(277.60±83.18)cGy、健侧肺V_(5)(2.10±1.35)%vs(14.06±8.62)%。P<0.05]。VMAT组γ通过率优于IMRT组,差异有统计学意义[3 mm/3%(99.72±0.20)%vs(99.38±0.37)%;2 mm/2%(97.22±1.05)%vs(96.99±0.91)%。P<0.05]。IMRT组照射时间(2.08±0.27)min,VMAT组照射时间(0.87±0.04)min,VMAT组节省超过55%照射时间,差异有统计学意义(P<0.05)。结论使用Halcyon直线加速器进行保乳术后放射治疗,IMRT计划和VMAT计划均能满足临床治疗需求,采用VMAT技术会提高靶区的剂量分布,明显提高计划执行效率。展开更多
Objective: It is unclear if and to what extent family history of breast/ovarian cancer or BRCA1/2-mutation carriership influences breast cancer treatment strategy. We investigated whether treatment differed between pa...Objective: It is unclear if and to what extent family history of breast/ovarian cancer or BRCA1/2-mutation carriership influences breast cancer treatment strategy. We investigated whether treatment differed between patients from BRCA1/2 families and those unselected for family history. Methods: We included 478 BRCA1/2-related patients referred for genetic testing before or after diagnosis. Two references were used: 13,498 population-based and 6896 hospital-based patients. Surgical treatment and adjuvant chemotherapy use was analyzed using logistic regression models, stratified by tumor size, nodal status, age at and period of diagnosis, and estrogen receptor status (ER). Results: BRCA1/2 cases aged 35 - 52 years at diagnosis and/or with tumors < 2 cm were more likely to have undergone a modified radical mastectomy (Odd Ratios (OR) ranging from 2.8 to 5.1) compared to the references. This effect was most pronounced in patients treated after 1995 (OR 5.7 to 10.3). Compared to the reference groups, chemotherapy was more often administered to BRCA1 and ER-negative BRCA1/2-cases irrespective of age and nodal status (OR 1.9 to 24.3). Conclusion: After 1995 treatment of BRCA1/2-associated patients consisted notably of more mastectomies and adjuvant chemotherapy than their population-based counterparts with the same tumor characteristics. There is a need to be aware of such differences in daily practice and interpretation of survival studies on BRCA1/2 mutation carriers.展开更多
文摘Background- To compare two types of therapy for primary breast carcinoma, breast-conserving therapy （BCT） and modified radical mastectomy （MRM）, in a matched cohort study. Methods： A series of 1,746 patients with primary breast cancer treated with BCT or MRM in a single Chinese institute between January 2000 and February 2009 were analyzed retrospectively to compare their outcomes with respect to the incidence of local recurrence （LR）, distant metastasis, and survival. The patients were matched with regard to age at diagnosis, spreading to axillary lymph nodes, hormone receptor status, the use of neoadjuvant chemotherapy and maximal tumor diameter. The match ratio was 1：1, and each arm included 873 patients. Results： The median follow-up period was 71 months. The 6-year disease-free survival （DFS） and 6-year distant disease-free survival （DDFS） rates differed significantly between two groups. The 6-year local recurrence-free survival （LRFS） rates were 98.2% [95% confidence interval （CI）： 0.973-0.989] in the BCT group and 98.7% （95% CI： 0.980-0.994） in the MRM group （P=0.182）, respectively. DFS rates in BCT and MRM groups were 91.3% （95% CI： 0.894-0.932） and 86.3% （95% CI： 0.840-0.886） （P〈0.001）, respectively, whereas the DDFS rates in BCT and MRM groups were 93.6% （95% CI： 0.922-0.950） and 87.7% （95% CI： 0.854-0.900） （P〈0.001）, respectively. Conclusions： BCT in eligible patients is as effective as MRM with respect to local tumor control, DFS and DDFS, and may result in a better outcome than MRM in Chinese primary breast cancer patients.
文摘We investigated the factors predicting radiation-induced organizing pneumonia (RIOP) relapse after tangential breast irradiation. The participants included 23 patients diagnosed with RIOP at the St. Marianna University School of Medicine Hospital between January 2008 and March 2015. Relapse was defined as the appearance of new lesions on diagnostic images during follow-up or after commencing treatment. The relapse-free survival rate and the following 9 parameters were compared between patients with and without RIOP relapse: 1) age (less than vs. equal to or more than the median);2) white blood cell count (less than vs. equal to or more than the median);3) C-reactive protein (CRP) level at the time of RIOP diagnosis (less than normal, more than normal/ less than borderline, and more than borderline);4) boost irradiation (yes vs. no);5) maximum lung depth on linacgraphy (less than vs. equal to or more than the median);6) hormone therapy (yes vs. no);7) chemotherapy (yes vs. no);8) RIOP ratio in the whole lung (less than vs. equal to or more than the median) at the time of RIOP diagnosis;and 9) use of corticosteroids (yes vs. no). The Kaplan-Meier method was used for statistical analysis, with relapse as the cutoff. The follow-up period spanned the date of RIOP onset to May 30, 2015. The level of significance for 2-sided tests was p < 0.05. Relapse was evident in 14 patients (60.8%). The relapse-free survival rate was significantly greater in the normal CRP group (less than 0.30 mg/dl) than in the abnormal CRP group (more than 0.36 mg/dl) (p = 0.044) and in the normal/borderline CRP group (less than 0.36 mg/dl) than in the high CRP group (more than 0.70 mg/dl) (p < 0.01). The CRP level at RIOP onset may be a useful predictor of relapse after breast-conserving therapy.We investigated the factors predicting radiation-induced organizing pneumonia (RIOP) relapse after tangential breast irradiation. The participants included 23 patients diagnosed with RIOP at the St. Marianna University School of Medicine Hospital between January 2008 and March 2015. Relapse was defined as the appearance of new lesions on diagnostic images during follow-up or after commencing treatment. The relapse-free survival rate and the following 9 parameters were compared between patients with and without RIOP relapse: 1) age (less than vs. equal to or more than the median);2) white blood cell count (less than vs. equal to or more than the median);3) C-reactive protein (CRP) level at the time of RIOP diagnosis (less than normal, more than normal/ less than borderline, and more than borderline);4) boost irradiation (yes vs. no);5) maximum lung depth on linacgraphy (less than vs. equal to or more than the median);6) hormone therapy (yes vs. no);7) chemotherapy (yes vs. no);8) RIOP ratio in the whole lung (less than vs. equal to or more than the median) at the time of RIOP diagnosis;and 9) use of corticosteroids (yes vs. no). The Kaplan-Meier method was used for statistical analysis, with relapse as the cutoff. The follow-up period spanned the date of RIOP onset to May 30, 2015. The level of significance for 2-sided tests was p < 0.05. Relapse was evident in 14 patients (60.8%). The relapse-free survival rate was significantly greater in the normal CRP group (less than 0.30 mg/dl) than in the abnormal CRP group (more than 0.36 mg/dl) (p = 0.044) and in the normal/borderline CRP group (less than 0.36 mg/dl) than in the high CRP group (more than 0.70 mg/dl) (p < 0.01). The CRP level at RIOP onset may be a useful predictor of relapse after breast-conserving therapy.
文摘Objective: To investigate the effect of breast-conservation therapy in early stage breast cancer. Methods: A total of 234 early stage breast carcinoma patients received breast conserving treatment in our hospital. After the operation, they underwent adjuvant chemotherapy and radiotherapy. All of these patients desired to preserve their breasts. Results: After median follow-up of 29.46 months (range from 3 to 100 months), 3 cases had local relapse and 8 cases had distant metastasis. The overall survival rate of 5 year was 96.7%, and the disease free survival rate of 5 year was 87.85%. Conclusion: For early stage breast carcinoma patients, classic quadrantectomy, axillary dissection and post-operative adjuvant chemotherapy and radiotherapy lead to excellent local control and good survival.
文摘Purpose: To evaluate long-term skin reactions following breast-conserving therapy by using the melanin-erythema index meter. Patients and Methods: 164 patients were followed for at least three years after breast-conserving therapy. For both the erythema and the melanin indices, the ratio of the irradiated-side index to the non-irradiated-side index was calculated. The time course of index ratios alternation was examined. Influences from additional therapies and patients’ age were also evaluated. Result: Both erythema and melanin index ratios of the breast skin were recovered to pre-radiation level three years after radiotherapy. However, both index ratios of the area administrated with 10-Gy boost irradiation were still high even after five years after radiotherapy. Endocrine therapy, chemotherapy and age had no significant influence on skin color reactions three years after radiotherapy. Conclusion: Quantitative assessment using the melanin-erythema index meter demonstrated that chronic skin reactions following breast conserving therapy had recovered to pre-radiation level for three years after irradiation except for the 10-Gy boost irradiated area.
基金supported by the Chinese National Natural Sciences Foundation (No. 81672623 and No. 81502306)
文摘Objective: The present study examined the effect of radiotherapy on recurrence and survival in elderly patients with hormone receptor-positive early breast cancer.Methods: A retrospective analysis of 327 patients aged ≥65 years, with stage I-II, hormone receptor-positive breast cancer who underwent breast-conserving surgery and received endocrine therapy(ET) or radiotherapy plus endocrine therapy(ET+RT) was performed. Both groups were divided into luminal A type and luminal B type subgroups. Evaluation criteria were 5-year disease-free survival(DFS), local relapse rate(LRR), overall survival(OS), and distant metastasis rate(DMR).Results: There were significant differences in 5-year DFS [hazard ratio(HR)=1.59, 95% confidence interval(95% CI), 1.15-2.19;P=0.005] and LRR(HR=3.33, 95% CI, 1.51-7.34;P=0.003), whereas there were no significant differences in OS and DMR between ET group and ET+RT group. In luminal A type, there was no significant difference in 5-year DFS, LRR, OS and DMR between ET group and ET+RT group. In luminal B type,there were statistically significant differences in 5-year DFS(HR=2.19, 95% CI, 1.37-3.49;P=0.001), LRR(HR=5.45, 95% CI, 1.65-17.98;P=0.005), and OS(HR=1.75, 95% CI, 1.01-3.05;P=0.048) between ET group and ET+RT group. In the ET group, there were significant differences between luminal A type and luminal B type in5-year DFS(HR=1.84, 95% CI, 1.23-2.75;P=0.003) and OS(HR=1.76, 95% CI, 1.07-2.91;P=0.026).Conclusions: After breast-conserving surgery, radiotherapy can reduce the LRR and improve the DFS and OS of luminal B type elderly patients, whereas luminal A type elderly patients do not benefit from radiotherapy.Without radiotherapy, luminal A type patients have better DFS and OS than luminal B type patients.
基金Supported by grants from the "Network Researches of Tumor Precise Radiation Therapy" of Ministry of Health of China (No. WKJ2005-3-006)the "Natural Science Foundation " of Science and Technology Commission of Shanghai (No. 06ZR4075)
文摘Objective The aim of this study was to evaluate the efficacy, complications and cosmetic results of three-dimensional conformal radiation therapy for early breast cancer after conservative surgery.
文摘Mammographic appearance of the normal breast is altered in the post-operative setting. It is essential to be aware of the normal findings as well as to identify features of recurrent disease with particular emphasis on radiologicalpathological concordance. Digital breast tomosynthesis and volumetric breast density add incremental value in this clinical setting. We present a pictorial review of various cases to illustrate normal post-operative findings as well as mammographic features suspicious for recurrent disease.
文摘影像学技术的进步使得越来越多的多灶性/多中心性乳腺癌(multifocal/multicentric breast cancer, MMBC)在早期被发现。传统观念认为,MMBC比单灶性乳腺癌(unifocal breast cancer, UBC)预后更差,应积极升级治疗手段。近年来,随着医疗水平的提升,MMBC患者的诊断、个体化治疗、接受保乳手术的安全性等焦点问题需重新被审视。本文将从MMBC流行病学特征、术前影像学评估、病理异质性与分子标志物、手术方式等多方面展开论述,以期加深临床认知。
文摘目的探究在Halcyon直线加速器上使用调强适形放射治疗(IMRT)和容积旋转调强放射治疗(VMAT)进行乳腺癌保乳术后放射治疗的临床应用。方法选择乳腺癌保乳术后放射治疗患者25例,年龄36~61岁,平均年龄50.9岁;左侧乳腺癌15例,右侧乳腺癌10例;肿瘤分期均为T1~T2、N0、M0。计划设计均在Eclipse计划系统上,每例患者分别采用IMRT和VMAT进行计划设计。对两类计划的主要剂量学参数、剂量分布、γ通过率和照射时间进行比较。结果所有计划均可临床使用,两组计划靶区D_(95%)、平均剂量D_(mean)差异较小(P>0.05),靶区均匀性指数(HI)(IMRT组0.06±0.01 vs VMAT组0.06±0.01),差异无统计学意义(P>0.05),适形性指数(CI)(IMRT组0.85±0.03 vs VMAT组0.92±0.02),差异有统计学意义(P<0.05)。IMRT组患侧肺V_(5)、V_(20)和平均剂量,心脏平均剂量,健侧肺V_(5)均低于VMAT组,差异具有统计学意义[患侧肺V_(5)(41.36±2.04)%vs(47.58±2.42)%、患侧肺V_(20)(15.04±2.90)%vs(16.35±1.97)%、患侧肺平均剂量(886.32±79.41)cGy vs(993.49±50.14)cGy、心脏平均剂量(209.23±98.12)cGy vs(277.60±83.18)cGy、健侧肺V_(5)(2.10±1.35)%vs(14.06±8.62)%。P<0.05]。VMAT组γ通过率优于IMRT组,差异有统计学意义[3 mm/3%(99.72±0.20)%vs(99.38±0.37)%;2 mm/2%(97.22±1.05)%vs(96.99±0.91)%。P<0.05]。IMRT组照射时间(2.08±0.27)min,VMAT组照射时间(0.87±0.04)min,VMAT组节省超过55%照射时间,差异有统计学意义(P<0.05)。结论使用Halcyon直线加速器进行保乳术后放射治疗,IMRT计划和VMAT计划均能满足临床治疗需求,采用VMAT技术会提高靶区的剂量分布,明显提高计划执行效率。
文摘Objective: It is unclear if and to what extent family history of breast/ovarian cancer or BRCA1/2-mutation carriership influences breast cancer treatment strategy. We investigated whether treatment differed between patients from BRCA1/2 families and those unselected for family history. Methods: We included 478 BRCA1/2-related patients referred for genetic testing before or after diagnosis. Two references were used: 13,498 population-based and 6896 hospital-based patients. Surgical treatment and adjuvant chemotherapy use was analyzed using logistic regression models, stratified by tumor size, nodal status, age at and period of diagnosis, and estrogen receptor status (ER). Results: BRCA1/2 cases aged 35 - 52 years at diagnosis and/or with tumors < 2 cm were more likely to have undergone a modified radical mastectomy (Odd Ratios (OR) ranging from 2.8 to 5.1) compared to the references. This effect was most pronounced in patients treated after 1995 (OR 5.7 to 10.3). Compared to the reference groups, chemotherapy was more often administered to BRCA1 and ER-negative BRCA1/2-cases irrespective of age and nodal status (OR 1.9 to 24.3). Conclusion: After 1995 treatment of BRCA1/2-associated patients consisted notably of more mastectomies and adjuvant chemotherapy than their population-based counterparts with the same tumor characteristics. There is a need to be aware of such differences in daily practice and interpretation of survival studies on BRCA1/2 mutation carriers.
