Late course three-dimensional conformal radiotherapy for esophageal carcinoma

Objective： The aim of our study was to evaluate the clinical results and acute side effects of late course three-dimensional conformal radiotherapy （3DCRT） for esophageal carcinoma. Methods： From January 2004 to October 2006, 70 patients with esophageal carcinoma received late course 3DCRT. Their clinical data were analyzed retrospectively. The short-term clinical results, acute side effects, local control rates and survival rates were evaluated. Results： The complete response rate was 62.9%, partial response rate was 35.7%, and the overall response rate was 98.6%. The 1-, 2-and 3-year local control rates were 77.1%, 51.4% and 45.7%, respectively. The 1-, 2-and 3-year overall survival rates were 75.7%, 54.3% and 38.6%, respectively. The median survival time was 26 months. Conclusion： The technique of late course 3DCRT is an effective treatment for esophageal carcinoma and tend to improve the overall survival rate.

Dosimetric study of five-field intensity-modulated radiotherapy compared with conventional three-dimensional conformal radiotherapy for rectal cancer

Objective： The aim of the study was to compare the difference of dose distribution in clinical target volume and organ at risk （OAR） between five-field intensity-modulated radiotherapy （IMRT） and conventional three-dimensional conformal radiotherapy （3DCRT） in the radiotherapy of rectal cancer. Methods： Fifteen patients with rectal cancer treated with radio- therapy （RT） were retrospectively analyzed. Among the patients, seven received RT preoperatively and 8 postoperatively. The target volume and the OARs such as the small bowel, bladder and femoral heads were contoured for each patient. 3DCRT-plan and IMRT-plan were performed for each patient respectively, with the prescribed dose covering at least 95% of the planning target volume （PTV）. The conformity index （CI） and homogeneity index （HI） were used for evaluation of the dose distribution in the target volume, and the Dx% （the lowest dose to the x% volume of the OARs that received the highest dose of irradiation） and the mean dose were used for evaluation of the dose to OARs. Paired-T test was used for companson of the difference between the two plans. Results： In the IMRT-plan and 3DCRT-plan, the CI were 0.94 and 0.87 （P = 0.000） and the HI were 1.13 and 1.17, respectively （P = 0.001）. For small bowel, the D30%, D50% and the mean dose were 19.67 Gy, 15.13 Gy and 18.81 Gy in the IMRT-plan and 25.20 Gy, 22.20 Gy and 22.89 Gy in the 3DCRT-plan, respectively （P 〈 0.001 for all pairs of parameters）. For bladder, the D30%, D50%, and the mean dose were 24.80 Gy, 34.20 Gy and 28.70 Gy in the IMRT- plan, and 35.07 Gy, 44.67 Gy and 35.68 Gy in the 3DCRT-plan, respectively （P 〈 0.001 for all pairs of parameters）. For femoral heads, the D5% in the IMRT-plan and 3DCRT-plan were 40.6 Gy and 40.47 Gy, respectively （P = 0.936）, and the mean dose were 30.14 Gy and 25.57 Gy, respectively （P = 0.001）. Conclusion： Five-field IMRT-plan is better than 3DCRT-plan in the conformity and the dose homogeneity within target volume and also better in sparing the small bowel and bladder.

Evaluation of whole-course three-dimensional conformal radiotherapy combined with late-course accelerated hyperfractionated radiotherapy for esophageal carcinoma patients

Objective： The aim of the study was to evaluate the therapeutic effect and safety of whole-course three-dimensional conformal radiotherapy （3DCRT） combined with late-course accelerated hyperfractionated radiotherapy （LCAFR） on patients with esophageal carcinoma. Methods： one hundred and one patients with esophageal carcinoma were divided into two groups. Observing group （49 cases） were treated by whole-course 3DCRT. Patients in control group （52 cases） were treated by conventional radiotherapy. Clinical efficiencies and radiation toxicities were compared between two groups. Results： The side effects including radiation esophagitis （63.2%） and tracheitis （49.0%） decreased in observing group, but there was no significant difference between two groups （69.2% and 55.7% in controls）. The 1-, 2-and 3-year tumor local control rates and overall survival rates in the observing group were significantly improved compared with the control group, being respectively 87.8%, 75.5%, 63.3% vs 71.2%, 55.8%, 42.3% and 85.7%, 71.4%, 46.7% vs 69.2%, 51.9%, 26.9% （all P 0.05）. Conclusion： The therapeutic effect of whole-course 3DCRT combined with LCAFR for esophageal carcinomas is superior to conventional radiotherapy.

Analysis of the efficacy and safety of conventional radiotherapy of chest wall and clavicular field and three-dimensional conformal radiotherapy in patients after modified radical mastectomy

Objective:To explore the efficacy and safety of conventional radiotherapy of chest wall and clavicular field and three-dimensional conformal radiotherapy in patients after modified radical mastectomy.Methods: A total of 84 patients who were admitted in our hospital after modified radical mastectomy were included in the study and divided into the conventional radiotherapy group (n=42) and the three-dimensional conformal radiotherapy group (n=42) according to different radiotherapy methods. The patients in the conventional radiotherapy group were given conventional radiotherapy of chest wall and clavicular field, while the patients in the three-dimensional conformal radiotherapy group were given three-dimensional conformal radiotherapy. The serum tumor markers and peripheral blood T lymphocyte subsets 6-8 weeks after treatment in the two groups were detected. The clinical efficacy, and toxic and side effects in the two groups were evaluated.Results: The serum CA15-3, CA125, CEA, and CK19 levels after treatment in the two groups were significantly reduced when compared with before treatment, CD3+,CD4+, and CD4+/CD8+ were significantly elevated, while CD8+ was significantly reduced when compared with before treatment, but the comparison of the above indicators between the two groups was not statistically significant. The occurrence rate of radioactive skin damage and pneumonia after treatment in the conventional radiotherapy group was significantly higher than that in the three-dimensional conformal radiotherapy group. Conclusions:The two kinds of radiotherapy schemes have an equal efficacy, but the toxic and side effects of three-dimensional conformal radiotherapy are significantly lower than those by the conventional radiotherapy, with a certain advantage.

Helical tomotherapy and volumetric modulated arc therapy:New therapeutic arms in the breast cancer radiotherapy

AIM To analyse clinical and dosimetric results of helical tomotherapy(HT) and volumetric modulated arc therapy(VMAT) in complex adjuvant breast and nodes irradiation.METHODS Seventy-three patients were included(31 HT and 42 VMAT). Dose were 63.8 Gy(HT) and 63.2 Gy(VMAT) in the tumour bed, 52.2 Gy in the breast, 50.4 Gy in supraclavicular nodes(SCN) and internal mammary chain(IMC) with HT and 52.2 Gy and 49.3 Gy in IMC and SCN with VMAT in 29 fractions. Margins to particle tracking velocimetry were greater in the VMAT cohort(7 mm vs 5 mm).RESULTS For the HT cohort, the coverage of clinical target volumes was as follows: Tumour bed: 99.4% ± 2.4%; breast: 98.4% ± 4.3%; SCN: 99.5% ± 1.2%; IMC:96.5% ± 13.9%. For the VMAT cohort, the coverage was as follows: Tumour bed: 99.7% ± 0.5%, breast: 99.3% ± 0.7%; SCN: 99.6% ± 1.4%; IMC: 99.3% ± 3%. For ipsilateral lung, Dmean and V20 were 13.6 ± 1.2 Gy, 21.1% ± 5%(HT) and 13.6 ± 1.4 Gy, 20.1% ± 3.2%(VMAT). Dmean and V30 of the heart were 7.4 ± 1.4 Gy, 1% ± 1%(HT) and 10.3 ± 4.2 Gy, 2.5% ± 3.9%(VMAT). For controlateral breast Dmean was 3.6 ± 0.2 Gy(HT) and 4.6 ± 0.9 Gy(VMAT). Acute skin toxicity grade 3 was 5% in the two cohorts.CONCLUSION HT and VMAT in complex adjuvant breast irradiation allow a good coverage of target volumes with an acceptable acute tolerance. A longer follow-up is needed to assess the impact of low doses to healthy tissues.

乳腺癌保乳术后应用3D技术填充瘤腔进行适形放疗的临床研究

目的探究乳腺癌保乳术后应用3D技术填充瘤腔进行适形放疗的靶区剂量、不良反应及美容度。方法选择2021年1月至2022年12月西安交通大学第一附属医院收治的48例乳腺癌患者,按照手术不同分为3D技术填充瘤腔组(24例)及对照组(24例)。全部患者均开展乳腺癌根治手术治疗,仅保乳方式不同,术后实施强度调控适形放射治疗计划下的加速部分乳腺照射。结果应用3D技术填充瘤腔保乳术后放疗的适形度指数及均匀性指数均明显高于常规保乳术后放疗(P<0.05)。3D技术填充瘤腔保乳术后放疗的肺及心脏危及器官剂量(平均剂量),肺的V 5、V 10、V 20、V 30、V 40及V 50均显著低于常规保乳术后放疗组(P<0.05)。2组患者的皮肤损伤、心律失常、骨髓抑制及消化道反应发生率差异无统计学意义。3D技术填充瘤腔保乳术后组患者的美容度要显著优于常规保乳术后患者(P<0.05)。结论乳腺癌保乳术后应用3D技术填充瘤腔显著增强乳腺的美容度,且不影响放疗的安全及有效性。

Initial outcome of induction chemotherapy followed by radiotherapy and concurrent weekly paclitaxel for stage Ⅲ non-small cell lung cancer

Objective： The aim of our study was to evaluate the toxicity and efficacy of induction chemotherapy （ICT） followed by three-dimensional conformal radiotherapy （3D CRT） and concurrent weekly paclitaxel on unresectable non-small cell lung cancer （NSCLC）. Methods： Stage III NSCLC patients with favorable conditions were treated with 2 to 4 cycles of carboplatin （AUC = 5-6, dl） combined with paclitaxel （175 mg/m〈 dl）, then followed by weekly paclitaxel （40 mg/m2） and concurrent 3D CRT within 3-4 weeks. The prescription dose was given as high as possible under the condition that V20 〈 31% and spinal cord dose 〈 50 Gy. Results： Thirty-one patients were enrolled. ICT was well tolerated. During the concurrent chemoradiotherapy, the treatment of 3 patients was ended ahead of the schedule because of severe pulmonary and heart toxicities; the treatment of 2 patients was delayed for 7 and 12 days because of fatigue. Myelosuppression was mild （16/31）： all were grade 1-2 except 1 was grade 3. Lymphocytopenia was more obvious （29/31, grade 3 in 21）. Three patients developed grade 3 radiation-induced esophagitis, and 2 developed grades 3-4 radiation-induced pneumonitis. Two developed grade 3 esophageal stricture. No grades 3-4 pulmonary fibrosis was observed. The overall response rate was 74.1%. The 1-, 2-, 3-year overall survival rates were 74.2%, 41.9%, and 34.6%, respectively, with the median survival time of 18.5 months. The 1-, 2-, 3-year local progression-freely survival rates were 64.5%, 32.3%, and 20.5%, respectively, with the median local progression-freely survival time of 14.3 months. Conclusion： The program of ICT followed by weekly paclitaxel and 3D CRT is accomplished in most of the favorable stage III NSCLC patients. The toxicity is tolerable, and the response rate is inspiriting.

早期乳腺癌保乳术后部分乳腺三维适形加速外照射剂量学研究

【目的】本研究通过对早期乳腺癌保乳术后部分乳腺三维适形加速外照射(APBI-3DCRT)计划设计的研究,旨在探讨中国女性早期乳腺癌保乳术后APBI-3DCRT剂量学分布特点及剂量学的可行性。【方法】选择50例保乳术后T1～2N0M0病例,利用三维治疗计划系统设计APBI-3DCRT计划及全乳腺照射(WBI)计划。按RTOG0319标准对50例APBI-3DCRT计划进行剂量学可行性评价;并比较正常组织在APBI-3DCRT和WBI计划中受量情况。【结果】50例APBI-3DCRT计划中评为Ⅰ级1例(2%);Ⅱ级46例(92%);Ⅲ级3例(6%)。与WBI相比,评价为Ⅰ～Ⅱ级APBI-3DCRT计划的患侧肺平均剂量(Dmean)以及至少接受20 Gy照射的体积百分比(V20)分别从9.259 Gy减少至1.637 Gy和从15.53%到1.79%,心脏的Dmean和V20分别从1.826 Gy减少至0.305 Gy和从3.14%到0.04%,对侧肺的最大剂量(Dmax)和Dmean分别从2.809 Gy减少至0.236 Gy和从1.107 Gy到0.102 Gy,对侧乳腺的Dmax和Dmean分别从2.391 Gy减少至0.231 Gy和从0.984 Gy到0.098 Gy,甲状腺的Dmax和Dmean分别从0.494 Gy减少至0.203 Gy和从0.203 Gy到0.078 Gy(P<0.05)。【结论】与WBI相比,APBI-3DCRT可以减少正常组织受照射的体积及照射剂量,有利于减轻正常组织的放射损伤;中国女性早期乳腺癌保乳术后进行APBI-3DCRT在剂量学上是可行的,建议进行Ⅰ/Ⅱ期的临床研究。

左侧乳腺癌保乳术后各种放疗技术剂量学评价

目的比较左侧乳腺癌保乳术后常规放疗（CR）、三维适形放疗（3D—CRT）、四野及五野调强放疗（IMRT）靶区剂量分布差异。方法随机选择14例左侧乳腺癌保乳术后患者，为每例患者设计上述4种照射技术的治疗计划。处方剂量为50Gy／25次。所有计划都使90％-95％靶区体积达到处方剂量要求。分别比较靶区剂量适形性、均匀性以及心肺所受剂量。结果3D—CRT和IMRT靶区剂量均匀度和适形度明显优于CR；IM—RT技术在正常组织的保护方面优于3D—CRT，3D—CRT技术优于CR。IMRT技术使患侧肺、心脏高剂量区体积降低，低剂量区增加，使对侧肺平均受照剂量增加。与四野[MRT相比，五野IMRT虽然改善了靶区的均匀性及适形度，但增加了患侧肺V5、V10及右肺平均剂量，而心脏及患侧肺高剂量区却无明显改善。结论与CR相比，3D—CRT和IMRT能够明显改善靶区均匀性和适形度，降低了患侧肺、心脏高剂量受照体积；在降低心脏及患侧肺高剂量体积方面，IMRT明显优于3D—CRT；四野IMRT是取代CR的最佳选择。

乳腺癌脑转移47例三维适形放疗疗效及预后分析

目的 评价三维适形放疗（three-dimensional conformal radiotherapy,3D-CRT）治疗乳腺癌脑转移临床疗效、不良反应以及预后。方法 回顾性分析北京军区总医院放疗科及解放军总医院放疗科1995年5月-2010年10月行全脑放疗（whole brain radiotherapy,WBRT）的47例乳腺癌脑转移患者（PTV 40～50 Gy/20～25 F或PTV 40 Gy/20 F）,脑转移灶（pGTV）同步加量至60 Gy/20 F（或后补量至60 Gy/30 F）,每周放疗5次。部分颅内复发患者再行立体定向放疗10～24 Gy/1～3 F。放疗结束1～3个月后评价疗效、不良反应,观察远期不良反应。结果 47例均完成放疗计划,其中CR 5例（10.6%）、PR 26例（55.3%）、SD 13例（27.7%）、PD 3例（6.4%）,总有效率（CR＋PR）66.0%,临床获益率（CR＋PR＋SD）93.6%。1、2、3年放疗生存率分别为53.2%（25例）、25.5%（12例）、2.1%（1例）,中位生存期13个月。急性不良反应主要为脑水肿、脱发、急性中耳炎、听力下降、皮肤反应、乏力、轻度骨髓抑制,2例（4.3%）出现Ⅲ～Ⅳ级神经系统晚期不良反应。单因素分析显示,放疗生存期与KPS相关。多因素分析显示,患者放疗生存期与KPS、临床分期、脑转移个数（〈3或≥3）、颅内转移灶进展相关。结论 三维适形放疗治疗乳腺癌脑转移能提高局控率,延长生存期;全脑照射40 Gy/20 F安全有效,不良反应可耐受。一般情况越好、临床分期越早、脑转移瘤个数越少、颅内病变进展越晚,生存期越长。

调强适形放疗在乳腺癌保乳术后应用的系统评价

目的评价早期乳腺癌保乳术后调强适形放疗(IMRT)的疗效。方法计算机检索中文科技期刊全文数据库、中国期刊全文数据库、数字化期刊全文数据库、中国生物医学文献数据库、PubMed、Cochrane Library、SCI及EMBASE数据库,并辅手工检索和其他检索。纳入比较早期乳腺癌保乳术后调强适形放疗与传统放疗(RT)的随机对照试验,根据Cochrane系统评价手册5.0.0质量评价标准进行质量评价,使用RevMan5.0软件进行Meta分析。结果共纳入4个研究(1 440例)。Meta分析显示,与RT相比,IMRT可降低急性湿性皮炎、乳房浮肿和色素沉着的发生。结论IMRT可明显降低急性湿性皮炎的发生,减轻患者痛苦,提高生活质量。

早期乳腺癌患者保乳术后体外部分乳腺加速照射的循证治疗

目的应用循证医学方法为1例行保乳术后的早期乳腺癌患者确定放疗方案。方法计算机检索Pub Med、Cochrane图书馆、CNKI、Wanfang和VIP数据库,纳入所有关于乳腺癌外照射部分乳腺加速放疗的随机对照试验,放疗技术不限。检索时限均为从建库至2015年10月31日。结果检索到3项随机对照试验。与全乳腺放疗相比,外照射加速部分乳腺放疗能够显著缩短放疗时间、不增加局部复发的风险,但提高美容效果、延长生存时间的作用有限。结论外照射加速部分乳腺放疗实现部分早期乳腺癌术后辅助放疗是可行的,但其疗效与远期生存结果仍需随机对照试验进一步研究。

左侧乳腺癌调强照射与适形放射剂量学的比较分析

目的:评价乳腺癌调强放疗和适形放疗靶区剂量分布的优缺点。方法:使用Eclipse Version三维治疗计划系统,对27例左侧乳腺癌保乳术后靶体积≥400 cm3分别行调强放射治疗和适形放射治疗两种治疗计划的制定。比较两种放射治疗计划的剂量分布和肺组织、心脏组织的受量。结果:处方剂量为50 Gy时,调强放射治疗和适形放射治疗靶区剂量分布是95%、105%及110%以上的相应等剂量线包围的体积V95%、V105%、V110%分别为97.8%、15.2%、0.5%和95.5%、28.6%、4.2%;肺组织的V20、V30、V40值分别为21.6%、12%、7%和27.6%、19.2%、17.4%,心脏的V20、V30、V40值分别为14.1%、4.3%、2.3%和30.1%、19.2%、13.2%。结论:靶区体积(PTV)≥400 cm3的乳腺癌患者行调强放疗的靶区剂量分布比适形放射治疗更理想,且肺、心脏受照射的剂量和体积也明显少于行适形放射治疗。

Ⅰ期乳腺癌保乳术后乳腺三维适形加速外照射的临床研究

目的探讨Ⅰ期乳腺癌保乳术后乳腺三维适形加速外照射(APBI-3DCRT)治疗的近期疗效。方法选择2003年2月至2006年3月在湖北省肿瘤医院行Ⅰ期乳腺癌保乳术后患者89例,自愿接受APBI-3DCRT治疗的患者57例为APBI-3DCRT组,全乳腺照射(WBI)治疗的患者32例为WBI组。使用8 MV光子线进行APBI-3DCRT和WBI计划设计,设定4～5个照射野,处方剂量为每次3.4 Gy,每天2次,间隔6 h,总剂量34 Gy。观察两组患者的生存率、复发率、急性放射性损伤发生率和乳房美容效果。结果 APBI-3DCRT组急性放射性皮肤反应发生率和肺损伤发生率(10.53%和5.26%)较WBI组(28.13%和18.75%)低(P<0.05)。APBI-3DCRT组乳房美容优良率(92.98%)较WBI组(75.00%)高(P<0.05)。结论Ⅰ期乳腺癌保乳术后APBI-3DCRT治疗近期疗效好。

乳腺癌保乳术后三维适形放疗致急性放射性肺损伤的相关因素分析

目的分析乳腺癌患者保乳术后i维适形放疗致急性放射性肺损伤的危险因素。方法收集2014年1～12月在本院行乳腺癌保乳术后接受i维适形放疗的86例患者临床资料，采用单因素及多因素logistic回归分析致急性放射性肺损伤的相关因素。结果急性放射性肺损伤发生率为10．47％（9／86）。单因素分析最示，照射野、患侧肺平均照射剂量及患侧肺V5、V10、V15、V20,V25与急性放射性肺损伤的发生有关（P〈O．05），多因素logistic回归分析显示V20是影响急性放射性肺损伤的独立危险因素（P〈O．001）。结论患侧肺V20是乳腺癌患者保乳术后行三维适形放疗致急性放射性肺损伤的独立危险因素。

乳腺癌传统适形放疗与三维调强放疗剂量学比较

目的评价乳腺癌传统适形放疗和调强放疗靶区剂量分布和心、肺组织接受的剂量。方法使用Eclipse三维治疗计划系统,对37例乳腺癌术后分别实施传统适形放射治疗和调强放射治疗计划。比较两种放射治疗计划的剂量分布和心、肺组织的受量。结果处方剂量为5000cGy时,调强放疗的靶区剂量分布更理想,且心、肺组织受照射剂量和体积也明显少于适形放射治疗。

乳腺癌保乳术后全乳放疗三种计划剂量学比较分析

目的比较左乳腺癌保乳术后采用常规(RT)、三维适形放射治疗(3DCRT)和调强放疗(IMRT)三种不同照射方法的剂量学差异。方法选择10例接受保乳手术的左侧早期乳腺癌患者,应用Eclipse7.3计划系统为每例患者分别设计常规、3DCRT和5野逆向IMRT三套放疗计划,均给予50Gy/25次,比较靶区、正常组织的受照剂量差异。结果 IMRT计划的剂量分布以及靶区适形性和均匀性均显著优于常规和3DCRT计划。RT、3DCRT、IMRT计划中患侧肺的V20分别为(29.4±4.6)%、(26.7±4.6)%、(22.6±1.8)%;患侧肺的V30分别为(26.4±5.2)%、(23.4±4.5)%、(16.2±1.6)%;心脏V30分别为(21.9±6.0)%、(14.6±3.5)%、(8.0±3.8)%,差异均具有统计学意义。结论与常规(RT)、3DCRT切线野计划相比,5野IMRT计划可以显著改善靶区的剂量分布,降低危及器官OARs(肺及心脏)高剂量受照体积,更好地保护心、肺组织,但同时增大了正常组织低剂量区受照体积。

同期化疗辅助全脑放疗联合三维适形调强局部加量治疗乳腺癌脑转移的临床研究

目的探讨同期化疗辅助全脑放疗联合三维适形调强局部加量治疗乳腺癌脑转移的临床疗效。方法回顾性分析92例乳腺癌脑转移患者的临床资料,依据治疗方法的不同将患者分为对照组(n=48)和试验组(n=44)。对照组患者采用全脑放疗联合三维适形调强局部加量治疗,试验组患者在上述放疗的基础上给予同期辅助化疗。评估两组患者的临床疗效、不良反应发生情况及生存质量。结果两组患者均顺利完成治疗。试验组患者的总有效率为31.8%(14/44),高于对照组的12.5%(6/48),差异有统计学意义(P﹤0.05);试验组和对照组患者的疾病控制率分别为86.4%(38/44)和75.0%(36/48),差异无统计学意义(P﹥0.05)。试验组患者的中位无进展生存时间(PFS)为4.6个月(95%CI:3.694~5.506),中位总生存时间(OS)为8.3个月(95%CI:6.739~9.861);对照组患者的中位PFS为3.3个月(95%CI:1.893~4.707),中位OS为6.0个月(95%CI:5.103~6.897)。试验组患者的中位PFS和中位OS均长于对照组,差异均有统计学意义(P﹤0.05)。两组患者均出现不同程度的不良反应,主要的3~4级不良反应为胃肠道反应、血小板减少和头痛,但患者均可耐受,均未中止治疗。试验组患者胃肠道反应的发生率为50.00%(22/44),明显高于对照组的16.67%(8/48),差异有统计学意义(P﹤0.01);其余不良反应的发生率比较,差异均无统计学意义(P﹥0.05)。治疗后两组患者的KPS评分均提高,且试验组患者的KPS评分明显高于对照组,差异均有统计学意义(P﹤0.01)。结论对乳腺癌脑转移患者进行同期化疗辅助全脑放疗联合三维适形调强局部加量治疗可获得较好的临床疗效,且不良反应可耐受。

早期乳腺癌保乳术后3D-CRT和IMRT-SIB治疗的近期美容疗效和急性放射性不良反应比较

目的比较三维适形放疗技术(three-dimensional conformal radiotherapy,3D-CRT)与调强放疗同步补量(intensity modulated radiation therapy with simultaneous integrated boost,IMRT-SIB)治疗保乳术后早期乳腺癌患者的急性放射性不良反应和近期美容疗效。方法选取86例保乳术后经3D-CRT(3D-CRT组41例)或IMRT-SIB(IMRTSIB组45例)治疗的女性早期乳腺癌患者。比较两组放射性皮肤损伤发生情况和美容效果。结果3D-CRT组较IMRT-SIB组患者出现较严重的放射性皮肤损伤(P<0.05)。3D-CRT组和IMRT-SIB组在美容效果方面比较,差异无统计学意义(P>0.05)。结论早期乳腺癌保乳术后,IMRT-SIB治疗较3D-CRT治疗可有效减少急性放射性不良反应的发生,二者在近期美容疗效方面均反应良好。

调强放疗与三维适形放疗对乳腺癌术后病人的疗效比较

目的:探究调强放疗(IMRT)与三维适形放疗(3D-CRT)对乳腺癌术后病人的治疗效果。方法:选取122例乳腺癌术后病人为研究对象,采用随机数字表法分为IMRT组与3D-CRT组,各61例。比较2组术后1年复发转移情况,并比较2组美容效果及急性放射性皮肤损伤发生情况,以及放疗前及放疗5周后血清激素[雌二醇(E2)、孕酮(P)]和肿瘤标志物[癌胚抗原(CEA)、糖类抗原153(CA153)]的变化。结果:术后1年,2组均未出现复发转移病例。IMRT组美容效果及优良率显著高于3D-CRT组(P<0.05),急性放射性皮肤损伤发生率低于3D-CRT组(P<0.05)。2组放疗前后血清E2和P水平差异无统计学意义(P>0.05)。放疗5周后,2组血清CA153和CEA水平均比放疗前下降(P<0.01),组间差异无统计学意义(P>0.05)。结论:IMRT及3D-CRT对乳腺癌术后放疗效果均较好,但IMRT在减少皮肤损伤、美容效果方面更具优势,于提升病人生活质量有积极意义。