乳腺癌术后分阶段放疗的临床观察

目的:探讨乳腺癌术后持续化疗与不同放疗方案的最佳组合,以求在不影响全身治疗和局部复发的前提下尽可能减少放疗的肺损伤和其他毒副反应。方法:临床病例选择后,根据不同的放化疗过程分为4组(A组:化疗 锁骨上野、腋窝野及胸壁切线野同时放疗 化疗组;B组:锁骨上野、腋窝野及胸壁切线野同时放疗 化疗组;C组:化疗 锁骨上野、腋窝野及胸壁切线野同时放疗组;D组:化疗 锁骨上野、腋窝野及胸壁切线野分阶段放疗组),并进行随访追踪。所有患者治疗结束后均随访3~5年。结果:A组放射性肺损伤发生率最高,而D组发生率最低,与其他各组比较差异均有统计学意义,B、C、D组与A组比较,P值分别为0.023、0.011和0.000,D组与B、C组比较,P值分别为0.015和0.007;4组局部复发率、远处转移率、5年生存率及骨髓抑制比较,差异均无统计学意义,P>0.05;放射性皮炎发生率A组最高,D组最低,与其他各组比较差异均有统计学意义,B、C、D组与A组比较,P值分别为0.033、0.042和0.014,D组与B、C组比较,P值分别为0.023和0.019。结论:乳腺癌术后化疗同时设野分阶段放疗可明显降低放射性肺损伤及其他毒副反应发生率,且不影响局部复发率、远处转移率及5年生存率。

Clinical research on the effect of radiotherapy by stages on radiotherapy-induced pulmonary injury of postoperative breast cancer

OBJECTIVE:To investigate the effect of radiotherapy by stages on radiotherapy-induced pulmonary injury and other by-effects combining with postoperative chemotherapy of breast cancer in order to find the most evaluable regime of breast cancer. METHODS:A total of 128 outpatients and inpatients were selected randomly. According to different regimes of postoperative therapy of breast cancer,they were divided into four groups. Simultaneously, the pulmonary symtom and physical exam, chest X-rays, the incidence rate of the recurrence and the remote metastatic rate in 5 years and survival rate in 5 years were used to evalue the therapeutic effect. Bone marrow depression and radiotherapy-induced cutitis were also observed. All the data were analyzed by SPSS. RESULTS: The patients who received radiotherapy by stages combining with postoperative chemotherapy of breast cancer had significantly lower incidence rate on radiotherapy-induced pulmonary injury and other by-effects, P<0.05. But there were no significant differences of the incidence rate of the recurrence, remote metastatic rate and survival rate in 5 years among the four groups, P>0.05. CONCLUSIONS: The incidence rate of radiotherapy-induced pulmonary injury in patients of postoperative therapy of breast cancer can be decreased greatly by radiotherapy by stages, and the incidence rate of the recurrence and the remote metastatic rate and survival rate in 5 years are not influenced.