术中光子线与术后外照射在早期乳腺癌保留乳房手术瘤床加量放疗中的近期疗效比较

目的比较早期乳腺癌保乳术后采用术中光子线对比术后外照射瘤床加量的安全性和可行性。 方法回顾性分析2014年12月至2018年6月中山大学附属第一医院甲状腺乳腺外科收治的222例早期乳腺行保乳手术患者的临床资料，其中72例采用术中光子线瘤床加量（术中放疗组），150例采用术后外照射瘤床加量（术后放疗组）。所有患者术后均行全乳±淋巴引流区外照射放疗，50 Gy/25 Fr。观察术后两组患者的不良反应、美容效果及近期疗效。 结果中位随访35个月（11~52个月），术中放疗组比术后放疗组有更低的乳腺纤维化发生率（2.8% vs 13.3%，χ²=6.071，P=0.014），但术后血肿的发生率更高（5.6% vs 0，P=0.015）。术后感染、坏死而引起切口延迟愈合、照射野内中度以上的乳腺疼痛，在两组间差异无统计学意义。术中放疗组和术后放疗组总体不良反应的发生率分别为13.9%和16.0%，美容效果优良率分别为83.3%（60/72）和89.3%（134/150），术后3年的局部复发率分别为0（0/72）和1.3%（2/150），差异均无统计学意义。 结论与术后外照射瘤床加量相比较，早期乳腺癌保乳术采用术中光子线的不良反应、美容效果和近期疗效相似。

Comparison intraoperative radiotherapy with external radiotherapy as a boost of tumor bed in breast-conserving surgery of early breast cancer

ObjectiveTo compare the adverse reaction and cosmetic effect of intraoperative radiotherapy using mobile photon beam with post-operative external radiotherapy as a boost to the tumor bed in patients with early-stage breast cancer receiving breast conserving surgery. MethodsThe clinical data of breast cancer patients who underwent breast-conserving surgery from December 2014 to June 2018 were analyzed retrospectively. Patients were divided into intraoperative radiotherapy (72 cases) and post-operative external radiotherapy (150 cases) groups. All patient were treated with radiation therapy to whole breast ± regional nodes at the dose of 50 Gy in 25 fractions. The adverse reaction and cosmetic effect were followed up as well as postoperative recurrence. ResultsMedian follow-up period was 35 months (11-52 months). Patients developed less breast fibrosis in intraoperative radiotherapy group compared with post-operative external radiotherapy group (2.8% vs 13.3%, χ²=6.071, P=0.014). However, patients developed more postoperative hematoma in intraoperative radiotherapy group compared with post-operative external radiotherapy group (5.6% vs 0, P=0.015). There is no significant difference between the postoperative infection and necrosis resulted in delayed incision healing and moderate or above breast pain in the irradiation field. The overall incidence of adverse reactions was 13.9% and 16.0% respectively, and the difference was not statistically significant. Patients had excellent or good cosmetic outcome was 83.3% in intraoperative radiotherapy group and 89.3% in post-operative external radiotherapy group. The 3-year local recurrentce rate was 0 in intraoperative radiotherapy group and 1.3% in post-operative external radiotherapy group. ConclusionCompared with postoperative external radiotherapy as a boost to the tumor bed, the intraoperative radiotherapy after breast-conserving surgery shows acceptable adverse reaction and similar cosmetic outcome as well as short-term efficacy.