乳腺癌保乳术后化疗加调强放疗的疗效观察

目的 观察Ⅰ、Ⅱ期乳腺癌保乳术后化疗加调强放疗的疗效及副反应.方法 108例Ⅰ、Ⅱ期乳腺癌患者均行肿瘤扩大切除及腋窝淋巴结清扫的保乳术,大部分患者瘤床放置银夹标记.术后采用NE(诺维本+表阿霉素)或TE(紫杉醇+表阿霉素)或CEF(环磷酰胺+表阿霉素+氟尿嘧啶)方案化疗6周期.化疗后全乳接受调强放疗50 Gy分25次,瘤床电子线补量10 Gy分5次.ER/PR阳性的患者均给予三苯氧胺为主的内分泌治疗.结果 随访截至2007年12月,随访率为100%,随访满1、2、3年的例数分别为108、88、58例.1、2、3年生存率分别为100%(108/108)、100%(88/88)、98%(57/58),局部复发3例;放疗期间出现不同程度的皮肤反应,乳房远期外观形状良好,未出现放射性肺炎、肺纤维化及心脏损伤等副反应.结论 Ⅰ、Ⅱ期乳腺癌保乳术后化疗加调强放疗生存率高,复发转移少,副反应轻,达到了提高患者生存质量及局部控制率目的 .

Clinical outcome of adjuvant chemotherapy plus intensity modulated radiotherapy after breust-con-serving surgery

Objective To evaluate the efficacy and side effects of adjuvant chemotherapy plus in-tensity modulated radiotherapy (IMRT) after breast-conserving surgery for stage Ⅰ and Ⅱ breast cancer.Methods After breast-conserving surgery, 108 patients received six cycles of chemotherapy followed by IM-RT. The irradiation dose of the whole breast was 50 Gy given by 25 fractions, followed by 10 Gy boost to the tumor bed given by 5 fractions with electron beams. Patients with positive estrone receptor or progesterone re-ceptor were given endocrine treatment, mostly with tamoxifen. Results The follow-up rate was 100% by December 2007. The number of patients followed-up at 1-, 2- and 3-year was 108,88 and 58. The 1-, 2- and 3-year over survival rates were 100% ,100% and 98%. Three patients had local recurrence. Different degree of dermatitis occurred with good long-term cosmetic results. No severe side effects occurred such as radiation-induced pneumonitis, pulmonary fibrosis and heart injury. Conclusions Breast cancer patients treated by adjuvant chemotherapy plus IMRT after breast-conserving surgery have high survival rate and low side-effect rate. The survival quality and local control can be improved.