早期乳腺癌保乳术后大分割放疗的研究

目的探讨早期乳腺癌保乳术后大分割放疗的疗效、美容效果及不良反应。方法选择2006-2009年陕西省人民医院收治的早期乳腺癌保乳手术后患者69例,其中36例行大分割放疗（大分割组）,两野切线全乳照射DT42.56 Gy,共16次,后续瘤床X线或电子线推量DT7.98 Gy,共3次,总疗程25-27 d;33例行常规分割放疗（常规组）,两野切线全乳照射DT50 Gy,共25次,后续瘤床X线或电子线推量DT10 Gy,共5次,总疗程40-42 d。应用SPSS 16.0软件行Kaplan-Meier法计算局部复发率和生存率,Log-rank法检验差异。χ2检验比较两组资料一般情况、美容效果及不良反应。以P〈0.05为差异有统计学意义。结果中位随访时间为61个月,随访率为100%。两组5年生存率均为100%。大分割组和常规组局部复发率分别为0.0%、3.0%（χ^2=0.28,P=0.600）。大分割组和常规组1级皮肤反应发生率分别为55.6%与51.5%（χ^2=0.11,P=0.737）,1级皮肤及皮下组织晚期反应发生率分别为13.9%与9.1%（χ^2=0.06,P=0.806）,1级白细胞减少发生率分别为8.3%与12.1%（χ^2=0.02,P=0.903）。大分割组和常规组1、3、5年美容效果优良率分别为85.7%与84.8%（χ^2=0.01,P=0.920）;88.2%与87.1%（χ^2=0.02,P=0.889）;87.1%与88.0%（χ^2=0.01,P=0.919）。结论保乳术后大分割放疗的疗效与常规分割相似,美容效果相当且未加重皮肤反应。

Clinical trial of hypofractionation radiotherapy for early stage breast cancer after breast conserving surgery

Objective To investigate the efficacy,cosmetic outcome and adverse reaction of hypofractionation radio therapy for early stage breast cancer after breast conserving surgery.Methods A total of 69 patients with early stage breast cancer after breast conserving surgery in People＇s Hospital of Shaanxi Province from 2006 to 2009 were includ ed.36 patients（HF group） were received whole-breast radiation to 42.56 Gy in 16 fractions followed by tumor bed boost of 7.98 Gy in 3 fractions;33 patients（CF group） were received whole-breast radiation to 50 Gy in 25 fractions followed by tumor bed boost of 10 Gy in 5 fractions.Kaplan-Meier of SPSS 16.0 was used to calculate local recur rence rates and the survival rates,the differences were compared by Log-rank test.Chi-square test was used to com pared the differences of the clinical characteristics,cosmetic outcome and toxicity between the two groups.Results The median follow-up time was 61 months,the follow-up rate was 100%.The 5-year overall survival rates were 100% in both groups.The local recurrence in HF and CF group was 0.0%,3.0% respectively（χ^2=0.28,P=0.600）.The incidence of grade 1 acute skin toxicity developed in CF and HF group was 55.6% and 51.5% respectively（χ^2=0.11,P=0.737）.Grade 1 late skin and subcutaneous tissue toxicity developed in HF and CF groups was 13.9% and 9.1% re spectively（χ^2=0.06,P=0.806）.Grade 1 neutropenia occurred in HF and CF groups was 8.3% and 12.1% respectively（χ^2=0.02,P =0.903）.The 1-,3-,5-year excellent and good rates of cosmetic outcomes of patients in HF and CF groups were 85.7% and 84.8%（χ^2=0.01,P=0.920）;88.2% and 87.1%（χ^2=0.02,P=0.889）;87.1% and 88.0%（χ^2= 0.01,P =0.919）.Conclusion Hypofractionation radiotherapy provides similar results to conventional radiotherapy in survival rate cosmetic outcome and toxicity.