T1-2N0-1M0期乳腺癌保乳术后大分割调强放疗近期临床观察

目的:观察T1-2N0-1M0期乳腺癌保乳术后大分割调强放疗的疗效、美容效果及不良反应。方法:选择2011年11月-2012年11月间就诊于山西省肿瘤医院乳腺疾病诊治中心的乳腺癌保乳患者41例，予大分割调强放疗，全乳计划靶体积43.5Gy/15次，瘤床区电子线补量8.7Gy/3次，2.9Gy/次，5次/周，疗程共24天。局部区域控制率和总生存率用Kaplan-Meier法计算。结果:中位随访时间27个月，随访率100%。3年局部区域控制率、生存率均为100%，急性放射性皮肤反应Ⅰ级4例，Ⅱ级3例；血液系统不良反应白细胞下降Ⅰ级5例，Ⅱ级3例，Ⅲ级2例；急性放射性肺炎I级2例，晚期放射性肺炎1例；患肢水肿轻度2例。放疗前、后美容效果评价优秀+良好率为95.1%、87.8%，放疗后1、3、6、12个月优秀+良好率均为90.2%。结论:早期乳腺癌保乳术后调强大分割放疗疗效和美容效果较好，且不良反应发生率低，可以缩短放疗时间。

The retrospective study of hypofractionated intensity -modulated radiotherapy in breast cancer after breast conserving surgery with stage T1-2N0-1M0

Objective:To observe the efficacy,cosmetic outcome and adverse reaction of hypofractionated intensity-modulated radiotherapy for T1-2N0-1M0 breast cancer after breast conserving surgery.Methods:From November 2011 to November 2012,41 patients with T1-2N0-1M0 breast cancer after breast conserving surgery in Shanxi Tumor Hospital were enrolled in the trial.The hypofractionated intensity-modulated radiotherapy was applied to each patient.The hypofractionated intensity-modulated radiotherapy was 43.5Gy/（15f·3w） to the whole breast,with a boost of 8.7Gy/（3f·3d） to the tumor bed.The dose was 2.9Gy per fraction,the total course of treatment was 24 days.Locoregional control and overall survival were calculated by Kaplan-Meier method.Results:The follow-up rate was 100%，the 3-year locoregional control and overall survival were both 100%.4 developed grade Ⅰ acute radiodermatitis,3 developed grade Ⅱ acute radiodermatitis,5 developed grade Ⅰ leukocyte reduction,3 developed grade Ⅱ leukocyte reduction,2 developed grade Ⅲ leukocyte reduction,2 developed grade Ⅰ acute radioactive pneumonia,1 developed grade late radioactive pneumonia,2 developed grade Ⅰ limb edema.The excellent and good rates of cosmetic outcomes before and after radiotherapy were 95.1%,87.8%,The 1-,3-,6-,12-month excellent and good rates of cosmetic outcomes after radiotherapy were 90.2%.Conclusion:The hypofractionated intensity-modulated radiotherapy for the patients with early-stage breast cancer after breast-conserving surgery have good therapeutic effects and cosmetic results,acceptable toxicities,low adverse reaction,as well as can shorten the time of radiotherapy.