乳腺癌保乳术后放疗疗效和美观效果

目的　观察乳腺癌保乳术后放疗的疗效和美观效果。方法　保乳术后全乳外照射和瘤床加量共10 9例,79例除应用高剂量率插植技术T1期肿瘤用单排插植,针距为1.5cm ,T2期以上肿瘤用双排或三排插植;针距间单次剂量(DB) 10～12Gy ,靶区周边剂量为85 %DB]外,其中4 8例还经组织间插植加量放疗;30例除采用电子线常规外照射15Gy外,其中2 7例还经电子线外照加量放疗。全乳照射应用6MV直线加速器,采用双切线半野照射技术,靶区剂量为4 5～5 2Gy(平均4 8.6Gy)。采用医生评分与患者问卷方法评价美观效果。结果　5年生存率为93.8% ,局部复发率为6 .5 %。全组无放射性溃疡发生,5例出现位于插植针孔周围急性皮肤炎症。在经临床随访体检的75例中,医生打分和患者自评满意度为优的比例分别占87%和81% (P >0 .0 5 )。两组满意度医生总评为优的患者比例分别为81.2 %和85 .2 % (P >0 .0 5 )。结论　乳腺癌保乳术后放疗可降低术后复发率,并发症少。不同的瘤床加量放疗方法不影响美观满意度。

Clinical outcome and cosmetic results of conservative surgery plus radiation therapy in early stage breast cancer patients

Objective To evaluate the clinical outcome and cosmetic results in early stage breast cancer patients treated with conservative surgery plus radia tion therapy. Methods From May 1995 to December 2002, 109 such patients were s o treated. The post-operative radiotherapy consisted of whole-breast 6?MV lin ear accelerator irradiation with two tangential half-fields to a total dose of 45- 52 ?Gy (mean 48.6?Gy), followed by a boost irradiation to the tumor bed. Among th em, 79 patients received 10-12 ?Gy(DB) boost by interstitial implantation brachyth era py ( 192 Ir HDR , Nucletron ), with single plane implantation for T1 a nd double pl ane implantation for T2 tumor. Thirty patients received 15?Gy boost by electron b eam. Adjuvant/concurrent chemotherapy (CMF or CEF) and hormonotherapy were also used according to the patients' clinical characteristics. The cosmetic results w ere scored by both the doctor and the patients. Results The overall actuarial 5-year survival was 93.8%, with local recurrence of 6.5%. No radiation-induced ulcer was observed in the breast except for acute inflammation at skin pinholes in 5 patients treated by interstitial implant brachytherapy. Among the 75 patie nts who had had breast examination, cosmetic result scored as good by patient a nd doctor were 81% and 87%, respectively. The good rate assessed by doctor in br achytherapy boost group and electron beam boost group were 81.2% (39/48) and 85. 2% (23/27), There was no significant difference between these two boost techniqu es (P>0.05). Conclusions Tumor bed boost irradiation by either brachytherapy or electron beam technique can provide satisfactory local control in early brea st cancer treated with conservative surgery plus radiotherapy without increasing the side effects. There is no significant difference in cosmetic result between these two boost techniques.