同时性双侧原发性乳腺癌术后放疗临床分析

目的:回顾性分析同时性双侧原发性乳腺癌(synchronous bilateral primary breast cancer,s BPBC)术后放疗的临床疗效及不良反应。方法:收集2006年9月至2015年4月在本院进行术后放疗的sBPBC患者14例,回顾性分析其病理临床特征,观察5年局部控制率(local control rate,LCR)、5年疾病无进展生存率(progression free survival,PFS)和5年总生存率(overall survival rate,OS)以及放射性皮肤反应、放射性肺炎、心脏毒性等不良反应。结果:14例sBPBC首发癌(第一癌)与次发癌(第二癌)中Luminal A型及TNBC较少,分子分型一致性较好(Kappa值=0.457)。sBPBC患者确诊时均无远处转移,第一癌中Ⅰ-Ⅱ期6例,占42.86%;第二癌Ⅰ-Ⅱ期10例,占71.43%,两者差异无统计学意义。所有患者均接受了术后放疗,未出现Ⅳ级反应,肺部及心脏仅有少量Ⅰ级毒性反应。Ⅲ级放射性反应仅出现于受照射皮肤,比例不到15%(4/28,14.29%)。双侧的皮肤、肺急性与晚期放射性反应均无明显差异。不论第一癌发生在左侧与否、左侧胸壁先照射与否,心脏毒性反应无差异,均轻微,无临床症状。共有4例(28.57%)s BPBC患者局部复发,5年LCR为81.5%;6例死亡,5年OS为71.4%,5年PFS为57.1%,中位生存期为95个月。结论:对于确诊的s BPBC患者应给予积极的综合治疗,可取得较好的局部控制及生存。sBPBC患者的术后放疗毒副反应轻,临床应用安全、有效。今后,对于单侧乳腺癌患者,应密切随访,以期早期诊断及治疗对侧乳腺癌,进一步提高BPBC患者的疗效。

Clinical analysis of postoperative radiotherapy for synchronous bilateral primary breast cancer

Objective:To retrospectively analyze the clinical efficacy and adverse reactions of postoperative radiotherapy for synchronous bilateral primary breast cancer (sBPBC).Methods:The data of 14 sBPBC patients were collected treated with postopera-tive radiotherapy among September 2006 to April 2015 in our hospital.Retrospectively analysis the clinical pathological features,obser-vation the 5 years local control rate (LCR),5 years disease progression free survival (PFS)and the 5 years overall survival rate (OS) and the adverse reactions of irradiation-induced adverse reactions of the skin,lung and heart etc.Results:Among 14 cases of sBPBC, Luminal A and TNBC types less presented and molecular types of the first cancer and the second cancer had good consistency (Kappa=0.457).No distant metastasis was observed in SBPBC patients upon diagnosis.6 and 10 stages Ⅰ-Ⅱ cases presented in the first cancer and the second cancer respectively,accounting for 42.86% and 71.43%.The difference was not statistically significant.All pa-tients received postoperative radiotherapy,with no grade IV reaction and only a few of the lungs and heart toxicities.Grade Ⅲ irradia-tion-induced reaction appeared only in the irradiated skin,accounting for less than 15% (4/28,14.29%).There were no significant difference between the acute and late radiation reactions of the bilateral lungs and skin.Regardless of whether the first cancer occurred in the left side and the left side of the chest or not,no difference in cardiac toxicity and clinical symptoms.A total of 4 cases (28.57%) of sBPBC patients presented local recurrence.The 5 years LCR was 81.5%,6 cases died,5 years OS 71.4%,PFS 57.1% and the me-dian survival period was 95 months.Conclusion:The active multimodality treatment should be given for sBPBC patients,and good local control and survival could be achieved.Postoperative radiation of sBPBC patients had minor toxicities of which the clinical application was safe and effective.In the future,the patients with unilateral breast cancer should be followed up closely to gain the early diagnosis and treatment of contralateral breast cancer.It would be possible to further improve the curative effect of BPBC patients.