早期乳腺癌保乳术后全乳大分割照射同步瘤床加量的临床分析

目的：观察早期乳腺癌保乳术后全乳大分割照射同步瘤床加量的短期疗效与不良反应。方法64例早期乳腺癌患者保乳术后行两野切线全乳照射，全乳腺照射40．5 Gy／15 f，单次剂量2．7 Gy／f，同步瘤床推量至48 Gy／15 f，单次剂量3．2 Gy／f，总疗程3周，观察分析患者局部复发情况、美容效果及不良反应。结果中位随访时间17月，随访率为100％，无局部复发情况发生。3例患者表现乳腺中度胀痛；Ⅰ、Ⅱ、Ⅲ级急性皮肤反应发生率分别为17．2％、4．7％、1．6％；Ⅰ级血小板下降发生率与Ⅰ～Ⅱ级中性粒细胞减少发生率分别为1．6％、4．7％；放疗完成后4、7月美容优良率分别为90．6％、87．5％。结论早期乳腺癌保乳术后全乳放疗同步瘤床加量的短期疗效与以往常规放疗方式相似，缩短放疗时间，不会增加皮肤不良反应及降低美容效果。

Clinical evaluation of whole breast radiotherapy with concomitant tumor bed boost for early stage breast cancer after breast-conserving surgery

Objective To evaluate the short-term efficacy and toxicity of whole breast radiotherapy with concomitant tumor bed boost for early stage breast cancer patients after breast-conserving surgery.Methods Sixty-four patients with early stage breast cancer after breast-conserving surgery were included.All patients received whole breast radiation of 40.5 Gy in 1 5 fractions (single dose irradiation 2.7 Gy)with concomitant tumor bed boost of 48 Gy in 1 5 fractions (single dose irradiation 3.2 Gy).The duration of irradiation was 3 weeks.The local recurrence rates,adverse effects and cosmetic out-comes were evaluated.Results The median follow-up time was 1 7 months with a 1 00.0%follow-up rate.No patient de-veloped local recurrence.Three patients had moderate breast tenderness.The incidence of grade Ⅰ,Ⅱ,Ⅲ acute skin toxicity was 1 7.2%,4.7% and 1 .6%,respectively;and the incidence of grade Ⅰthrombopenia and gradeⅠ-Ⅱneutro-penia was 1 .6%and 4.7%,respectively.Besides,90.6%and 87.5%of patients had excellent or good cosmetic outcome at 4 months and 7 months after the completion of radiotherapy.Conclusion The short-term efficacy,cosmetic outcome and side effects of whole breast radiotherapy with concomitant tumor bed boost was similar to conventional radiotherapy for early stage breast cancer patients after breast-conserving surgery.