乳腺癌保乳术后大分割放疗急性毒性及生命质量

目的探讨中国女性乳腺癌患者保乳术后大分割放疗期间的急性放射性毒性和生命质量情况。方法广州医科大学附属肿瘤医院符合入组条件的30例乳腺癌保乳术后患者,年龄26~67岁,随机分至大分割研究组(14例)和常规分割对照组(16例)。全乳调强放疗剂量:大分割组40.5Gy/15f/21d,常规分割组50Gy/25f/35d;瘤床加量:大分割组至46.5Gy/16f/22d,常规分割组至60Gy/30f/42d。结果所有患者急性放射性皮炎均列为Ⅰ~Ⅱ度,研究组和对照组急性皮肤毒性未见显著统计学差异(P>0.05)。所有患者均未见明显放射性心、肺毒性出现。生命质量结果显示:除情感状况(EWB)指标研究组较对照组差(P<0.05)外,其余5个指标(包括量表总得分TOTAL在内)两组得分均未见统计学差异(P>0.05)。结论中国女性乳腺癌患者保乳术后瘤床加量大分割放疗具有与常规分割放疗耐受良好,提示具有同等的急性毒性和生命质量情况。     

原发性早期乳腺癌保乳手术后五年原位复发特点分析

目的 总结原发性早期乳腺癌保乳手术后5年原位复发的特点.方法 2000年5月至2005年5月保乳手术治疗原发性早期乳腺癌47例,行象限切除加腋窝淋巴结清扫39例,单纯肿块局部广泛切除术无腋窝淋巴结清扫8例,其中术后行全乳切线加瘤床放疗40例.结果 随访5～10(7.0±1.5)年,原位复发3例,占6.4%(3/47),均为非浸润性癌.术后行全乳切线加瘤床放疗者原位复发率(2.5%,1/40)低于未行全乳放疗者(28.6%,2/7)(P=0.035),行象限切除加腋窝淋巴结清扫者原位复发率(2.6%,1/39)低于行单纯肿块局部广泛切除术无腋窝淋巴结清扫者(25.0%,2/8)(P=0.029).结论 原发性早期乳腺癌保乳手术后放疗及象限切除加腋窝淋巴结清扫是必要的,可降低5年原位复发率.     

30例早期乳腺癌保乳术后部分乳腺三维适形外照射的临床观察

目的探讨早期乳腺癌患者进行部分乳腺三维适形加速外照射(accelerated partial-berast irradiation,APBI-3DCRT)的临床可行性、不良反应和美容效果。方法 2006年5月~2009年3月选择早期乳腺癌保乳术后患者30例,放疗处方剂量为3.4 Gy/次,2次/d,总剂量为34 Gy,两次治疗间隔6 h。结果 9例患者的治疗计划评价为优秀级,21例患者的治疗计划评价为可接受级,患者急性放射性反应轻微,美容效果均为优秀,无病例发生局部复发或远处转移。结论 APBI-3DCRT摆位重复性好、技术可行、急性放射性反应轻微、美容效果优良。     

乳腺癌保乳手术后放疗的护理

乳腺癌是女性常见的恶性肿瘤之一。在中国乳腺癌的发病率呈逐年上升的趋势,对于乳腺癌传统的治疗方法是采用乳腺根治术。近年来,欧美国家已将保乳手术加根治性放疗作为早期乳腺癌治疗的一个重要方法。在众多前瞻性随机研究的基础上进行的三个Meta综合分析进一步证实,保乳手术加根治性放疗与乳腺根治术相比其局部控制率、远处转移率、生存率均与乳腺癌根治术无差别,保乳手术加根     

40例早期乳癌保乳术后放射治疗的临床观察

目的：观察早期乳腺癌保乳手术后放射治疗的疗效、美容效果及并发症。方法：对40例早期乳腺癌患者行保乳手术,术后联合放射治疗,采用全乳切线野照射50Gy／25Fx,后瘤床补量14or／7Fx。腋窝淋巴结阳性者,患侧锁骨上x线和电子线混合照射50G弘结果：随访12～62个月,1年生存率100％,3年生存率95％,5年生存率92．5％。近期美容效果患者自评满意度佳、良者92．5％。无局部复发。3例远处转移,3例放射性肺炎,9例急性放射性皮肤反应,无Ⅲ-Ⅳ度骨髓抑制。结论：放射治疗可使早期乳腺癌保乳患者术后获得满意的生存率和美容效果,提高了患者的生活质量。     

早期乳腺癌患者65例保乳术后放疗的临床疗效观察

目的 探讨早期行乳腺癌保留乳房手术的临床治疗效果.方法 对近年来入住笔者所在医院行乳腺癌保乳术65例患者的临床资料进行回顾性分析,均行术后放疗,记录分析其5年生存率、局部复发率及远处转移率,并评估放疗对乳房外观的影响.结果 65例患者经随访发现,总复发率6.2%,5年生存率96.9%（63/65）,5年无瘤生存率93.8%,无严重放疗反应发生,乳腺癌保乳术对患者乳房美观不会产生不利影响.结论 早期乳腺癌保乳术后放射治疗与根治术具有相似的的治疗效果,结合三维适形放疗无严重并发症,保留乳房,达到美观效果.     

全脑调强放疗同期推量治疗脑转移瘤的疗效观察

目的 探讨多处方剂量融合正向调强全脑放疗同期推量治疗计划在治疗脑转移瘤中的可行性。方法 20例脑转移瘤患者,利用Pinnacle6.2适形治疗计划系统,进行全脑放疗同期推量治疗:全脑放疗TD30Gy/10F,转移瘤推量20Gy/10F。结果 所有患者均顺利完成治疗,未出现临床不可接受的副反应。结论 多处方剂量融合正向调强全脑放疗同期推量治疗脑转移瘤,在临床上是可行的,对于KPS评分较好,原发病灶控制的脑转遗瘤患者可以推荐使用。     

全脑照射联合三维适形放疗治疗肺癌脑转移瘤疗效观察

目的 探讨全脑照射联合三维适形放疗(3D CRT)治疗肺癌脑转移瘤的疗效.方法 对我院2006年10月至2010年12月收治的86例患者进行回顾性分析,其中观察组48例先行全脑放疗DT40Gy/20F后,局部病灶缩野时针对可见病灶行三维适形放疗(3D CRT)加量至50Gy;对照组38例单纯接受全脑放疗DT40Gy/20F.结果 所有患者均顺利完成放疗,未出现严重副反应及并发症,观察组与对照组局部控制率分别为91.7％,68.4％(P＜0.01);中位生存时间分别为9.3个月、6.4个月、1年生存率分别为31.3％,23.7％(P＞0.05),治疗失败多为肿瘤复发或全身多处转移.结论 全脑照射联合三维适形放疗(3D CRT)能有效提高患者局部控制率,改善生活质量及一定程度上延长生存期.     

旋转式伽玛刀联合全脑放疗治疗脑转移瘤

目的：探讨头部伽玛刀联合全脑放疗治疗脑转移瘤的疗效。方法：将120例1～5个脑转移瘤患者随机（根据入院先后顺序,每组一例）分为两组,实验组60例,患者接受全脑放疗30Gy/15f/3w,后加旋转式头部伽玛刀治疗12～16Gy/1f（WBRT＋SRS组）;对照组60例,患者接受全脑放疗40Gy/20f/4w（WBRT组）。观察两组患者的临床效果和并发症,并进行统计处理,分析两组患者的1年局部控制率和1年生存率。结果：两组患者均取得良好效果,未出现严重毒副作用;实验组和对照组1年局部控制率分别为83.6%、24.3%;1年生存率分别为64.7%、20.1%。实验组1年局部控制率和1年生存率明显高于对照组,差异有统计学意义（P〈0.01）,且无明显不良反应。结论：头部伽玛刀联合全脑放疗治疗脑转移瘤患者,安全有效,可明显提高脑转移瘤患者的1年局部控制率和1年生存率。     

早期乳腺癌保乳术后俯卧位全乳放疗研究进展

早期乳腺癌患者保乳术后全乳放射治疗（简称放疗）可有效提高局部控制率和降低术后复发风险,俯卧位全乳放疗较仰卧位对于部分大体积乳腺患者可带来明显的剂量学优势和美容效果。随着多种放疗技术和辅助工具的出现,俯卧位全乳放疗对靶区和不同危及器官（如心、肺等）的照射体积和剂量也发生了不同变化。有机构已初步探寻出患者在无需俯卧位和仰卧位双重模拟CT扫描和计划评估的情况下便可选择出较优治疗体位的预测模型,并尝试运用于临床实践中。本文就早期乳腺癌保乳术后俯卧位全乳放疗发展至今的相关技术对比及在剂量研究方面的进展做一简要综述。     

Is there an indication for additional local irradiation in conserving treatment of breast cancer patients aged 60 and over?

Recent results from the European Organisation for Research and Treatment of Cancer (EORTC) trial of additional irradiation in patients with breast cancer, show that after breast-conserving surgery and radiotherapy (50 Gy) of the whole breast, an additional dose of 16 Gy on the tumour bed significantly reduces the local recurrence rate from 7.3% to 4.3%. A relative reduction was seen in all age groups but was most significant in patients aged 40 years and below (19.5% versus 10.2%). In women aged 60 years and over, the local recurrence rate after radiotherapy of 50 Gy (without the additional radiation dose) is already very low (4.0%). Therefore it is questionable whether an additional dose of 16 Gy (reducing the recurrence rate to 2.5%) is still justified as a standard treatment in this age group.     

替莫唑胺联合全脑放疗治疗乳腺癌脑转移的临床观察

目的探讨替莫唑胺联合全脑放疗治疗乳腺癌脑转移的疗效和安全性。方法 2007年6月至2010年10月我科共治疗21例乳腺癌脑转移患者。给药方法：替莫唑胺75mg/m2,口服,从放疗第一天开始至结束。放疗结束后,替莫唑胺150mg/m2,d1～d5,连服5天,28天重复,连服2周期。放疗采用全脑照射（whole brain radiotherapy,WBRT）,DT40GY/20f/4W;部分患者加用γ刀治疗,DT18GY。结果全组总有效率为76.2%（CR＋PR）,其中CR3例（14.3%）,PR13例（61.9%）。中位生存期为11.2个月,中位缓解期为9个月。血液毒性主要为Ⅰ～Ⅱ度白细胞下降（71.4%）。非血液毒性主要为胃肠道反应。结论替莫唑胺联合全脑放疗治疗乳腺癌脑转移是有效安全的,可一定程度延长生存时间。     

Modern radiotherapy after breast-conserving surgery

In the last four decades breast-conserving surgery followed by whole breast irradiation has become the standard of care for the treatment of early-stage (0-I-II) breast carcinoma. With the advent of breast-screening, incidence of breast carcinomas with more favorable prognostic characteristics has increased significantly. This change in the prognostic profile of newly diagnosed breast cancers opened a new horizon for clinical research seeking for individual risk-adapted protocols of breast cancer radiotherapy. Several groups have been tested the efficacy of accelerated (partial or whole) breast irradiation, which has become the new treatment paradigm in the radiotherapy of early-stage breast cancers. Furthermore, others have attempted to identify subgroups of patients for whom radiotherapy after breast-conserving surgery could be safely omitted. Recently molecular gene expression assays have emerged as promising prognostic and predictive markers for local recurrence. This article reviews the results of these studies focusing on individual risk-adapted radiotherapy after breast-conserving surgery for patients with early-stage breast carcinoma.     

乳腺癌保乳术后应用放射治疗的临床效果探究

目的：探讨乳腺癌保乳术后应用放射治疗的临床效果。方法：选取2009年1月-2011年12月本院收治的86例早期乳腺癌患者，按照随机数字表法以1：1随机化分组将所有患者分为观察组和对照组各43例，其中观察组采用保乳术后放射治疗，而对照组单纯应用保乳手术治疗，比较分析两组患者的术后治疗情况。结果：观察组的复发率为2．32％，转移率为4．65％，均明显低于对照组的6．97％和18．60％，差异均有统计学意义（P〈0．05）。结论：乳腺癌保乳术后应用放射治疗的临床疗效显著，患者的生存质量得到提高，适合临床推广及应用。     

早期乳腺癌保乳手术治疗的临床观察

目的回顾分析早期乳腺癌保留乳房手术治疗的临床效果,评价保乳术后改良放疗对远期疗效的影响。方法 2004年1月-2006年1月我科就诊的90例早期乳腺癌患者,单盲随机将接受改良放疗保乳术治疗的49例患者分为改良组,其余41例分为对照组。对照分析术后患者对乳房美容效果评价、术后复发及转移和放疗不良反应结果。结果两组患者对乳房美容效果评价差异无统计学意义（P〉0.05）。改良组放射性皮炎高于对照组,差异有统计学意义（P〈0.01）。两组患者局部复发率及淋巴结复发率差异无统计学意义（P〉0.05）,而远处转移率差异有统计学意义（P〈0.01）。而血小板下降及白细胞下降等毒性反应差异无统计学意义（P〉0.05）。结论保乳术后改良放疗可有效降低远处转移率,提高患者生活质量,可在临床中推广,以进一步提高患者术后的生存率。     

Epithelial ovarian cancer: definitive radiotherapy for limited recurrence after complete remission had been achieved with aggressive front-line therapy

The purpose of this study was to assess the efficacy and toxicity of definitive radiotherapy (RT) for the recurrence of epithelial ovarian cancer, which is limited to one or two gross regions, after complete remission had been achieved with aggressive front-line therapy. Twenty-seven patients were treated with definitive RT and were retrospectively analyzed. Their median tumor size was 3.0 cm. Twenty-six (96%) patients received external irradiation at a median total dose of 60 Gy, and a median daily dose of 2 Gy. Only two patients received intracavitary brachytherapy. Twenty (74%) of the 27 patients received systemic chemotherapy for the treatment of a limited recurrent tumor followed by definitive RT. Six (22%) of the patients received concurrent chemotherapy and seven (26%) of the patients also underwent regional hyperthermia during definitive RT. Twenty-two (82%) patients had an objective response (CR: 11, PR: 11). The 2-year overall survival, progression-free survival and local (in-field) control rates after RT were 53%, 39% and 96%, respectively. The toxicities were mild, no Grade 3 or higher toxicity was observed in any of the patients. The tumor size( < 3 cm), period between front-line therapy and RT (≥2 year) and objective tumor response (CR) were significant prognostic factors of the overall survival rate. In conclusion, definitive RT for limited recurrence of epithelial ovarian cancer achieves a better local control rate without severe toxicity, and it may therefore be a potentially effective modality for inducing long-term survival in selected patients.     

Brachytherapy of the tumor bed after breast conserving surgery: new radiotherapeutic option in the management of early breast cancer]

PURPOSE: To initiate fractionated, interstitial high dose rate brachytherapy of the tumour bed as the sole radiation modality after breast conserving surgery. PATIENTS AND METHODS: In 41 cases of selected stage I-II breast cancer the tumour bed was marked with titanium clips during breast conserving surgery. The tumour bed was implanted with flexible plastic catheters to deliver postoperative radiotherapy. In 8 cases 7 x 4.33 Gy (30.3 Gy), in 33 cases 7 x 5.2 Gy (36.4 Gy) interstitial 192Ir high dose rate brachytherapy was given to the clipped area. Irradiation of the whole conserved breast was omitted. The radiation side effects were assessed by mammograms and MRI-examinations. RESULTS: At a median follow up of 17 (4-36) months neither distant nor regional failure was observed. Local recurrence was detected in 1/41 (2.4%) case. G2 radiation side effects were observed in 2/21 (9.5%). CONCLUSIONS: Postoperative sole brachytherapy of the tumour bed with careful patient selection and adequate quality assurance seems to be a feasible alternative to whole breast teletherapy. Sole brachytherapy shortens the time of radiotherapy from 5-6 weeks to 5 days, and reduces the costs of treatment. The skin and volume sparing effect of interstitial irradiation may decrease the side effects of radiotherapy.