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广东省早期乳腺癌保留乳房术后放射治疗现状的调查
引用本文:黄晓波,刘宜敏,林焕新,崔念基,管迅行,刘孟忠.广东省早期乳腺癌保留乳房术后放射治疗现状的调查[J].肿瘤防治研究,2010,37(10):1192-1196.
作者姓名:黄晓波  刘宜敏  林焕新  崔念基  管迅行  刘孟忠
作者单位:1. 510060广州,华南肿瘤学国家重点实验室;2.中山大学肿瘤防治中心放射治疗科;3.中山大学第二附属医院放射治疗科
摘    要:目的 全面评估广东省开展乳腺癌保留乳房手术(Breast conserving surgery, BCS)后放射治疗的现状。 方法 2007年6月—2008年6月,针对BCS后放疗的概况、靶区和放疗技术、综合治疗时序等问题,在广东省放疗单位中进行问卷调查。 结果 共27家单位开展乳腺癌BCS后放疗,其患者占乳腺癌年收治总例数的中位百分数是7.3%(3.9%~22.5%)。所有单位均常规选择照射全乳+瘤床。全乳光子线切线野照射中分别有88.9%和25.9%的单位加楔形板和皮肤填充物;瘤床照射以电子线为主(85.2%),仅18.5%的单位选择手术金属夹标志外扩1~1.5cm作为瘤床照射范围,全乳照射与瘤床推量照射中位剂量分别为50Gy(42.5~50Gy)和10Gy(10~20Gy)。术后放化疗时序以认可“化-放-化”夹心模式的单位为多,占70.3%,手术到术后放疗的间隔中位时间为8周(2~32周)。 结论 广东省仍需加大推广保留乳房治疗的力度,目前各放疗单位在靶区选择全乳+瘤床照射上比较一致,但对放疗技术和放化疗时序选择上仍存分歧,尚须进一步专业培训和更多前瞻性临床证据来指导临床决策。

关 键 词:乳腺肿瘤  放射疗法  保留乳房手术  靶区  治疗时序  问卷调查  
收稿时间:2009-7-21
修稿时间:2010-1-15

Survey on Current Status of Radiotherapy after Breast Conserving Surgery for Breast Cancer in Guangdong Province
HUANG Xiao-bo,LIU Yi-min,LIN Huan-xin,CUI Nian-ji,GUAN Xun-xing,LIU Meng-zhong.Survey on Current Status of Radiotherapy after Breast Conserving Surgery for Breast Cancer in Guangdong Province[J].Cancer Research on Prevention and Treatment,2010,37(10):1192-1196.
Authors:HUANG Xiao-bo  LIU Yi-min  LIN Huan-xin  CUI Nian-ji  GUAN Xun-xing  LIU Meng-zhong
Institution:1.State Key Laboratory of Oncology in South China,Guangzhou 510060, China; 2.Department of Radiotherapy, Cancer Center, Sun Yat-sen University;3.Department of Radiation Oncology, Second Affiliated Hospital of Sun Yat-sen University
Abstract:Objective To comprehensively access current status of radiotherapy after breast conserving surgery(BCS) for breast cancer in Guangdong Province. Methods From June, 2007 to June, 2008, questionnaires on the general information, targets selection and radiotherapy techniques, sequence with adjuvant chemotherapy and radiotherapy after BCS were sent to the departments of radiotherapy of different hospitals throughout Guangdong Province. Results Total 27 departments performed radiotherapy after BCS. The median ratio of patients with radiotherapy after BCS accounting for all new-diagnosed breast cancer patients was 7.3%(3.9%~22.5%). All departments applied intact breast plus tumor bed irradiation routinely. For intact breast photon tangential irradiation, proportions of departments who added wedge or bolus were 88.9% and 25.9% respectively. For tumor bed boost irradiation, electron beam was the most common technique (performed 85.2%), and proportion of departments who took the volume of expanding 1~1.5cm from surgical clip marks as boost volume was only 18.5%. In addition, the median total doses to intact breast and tumor bed boosting were 50Gy(42.5~50Gy) and 10Gy(10~20Gy) respectively. The most common sequence of radiotherapy and chemotherapy was sandwich mode of “chemotherapy-radiotherapy chemotherapy”, performed 70.3%. The median interval between surgery and radiotherapy was 8 weeks(2~32 weeks). Conclusion Guangdong Province still required to enhance breast conserving treatment. A consensus has been reached that intact breast plus tumor bed should be taken as routine irradiated targets, however, there was still controversy in the decision for appropriate irradiation techniques and optimal sequence of radiotherapy and chemotherapy, which might reach through advanced professional training and further prospective clinical evidences to guide clinical practice.
Keywords:Breast neoplasms  Radiotherapy  Breast conserving surgery  Target  Treatment sequence  Questionaires
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