早期乳腺癌保乳术后三维适形放疗美容效果及近期疗效的比较研究

目的探讨早期乳腺癌保乳术后常规放疗和三维适形放疗疗效、副作用和治疗后的美容效果。方法106例患者中,62例常规放疗(CR),46例三维适形放疗(3DCRT)。放疗范围根据肿块大小、部位、腋淋巴结是否受累而定。应用直线加速器6 MV X线照射,处方剂量50 Gy5周,瘤床追加6～9 MeV电子线10～15 Gy1.0～1.5周。结果CR组复发3例,远处转移5例,死亡2例;3DCRT组复发1例,远处转移4例,死亡2例。两组放疗后局部复发率、远处转移率与死亡率差异无统计学意义(P均>0.05)。CR组中11例发生了放射性肺炎,3DCRT组无放射性肺炎发生(P<0.01)。放疗后0.5、1.0年美容效果达优良者CR组分别占90%、93%,3DCRT分别占92%、94%(P>0.05)。结论早期乳腺癌保乳术后3DCRT在近期疗效和美容效果等方面与CR相似,但前者可明显降低放疗并发症。

Clinical outcome of three dimensional conformal radiation therapy for early breast cancer after conservative surgery

Objective To compare the efficacy, complications, cosmetic results between conven- tional radiotherapy (CR) and three dimensional conformal radiation therapy (3DCRT) after conservative surgery for early breast cancer. Methods Totally 106 patients underwent postoperative radiotherapy after breast-conserving surgery, including 62 patients who received CR and 46 received 3DCRT. The radiation dose was determined by the tumor size, tumor location and axillary node involvement. Tangential fields were used to deliver 6 MV X-ray beams to a total dose of 50 Gy in 5 weeks. An additional 10-15 Gy was given to the tumor bed with 6-9 MeV electron beams in 1.0-1.5 weeks. The median follow-up time was 32 months. Results The local recurrence, metastasis or death were observed in 3,5 and 2 patients in the CR group, while 1,4 and 2 in the 3DCRT group. No statistical significant difference was found between these two groups (P>0.05). Radiation induced pneumonia was observed in 11 patients in CR group versus none in the 3DCRT group. Six months and one year after radiotherapy, 90% and 93% of these patients were as- sessed as excellent or in fine cosmetic state in the CR group, versus 91.5% and 93.8% in the 3DCRT group. There was no significant difference in the cosmetic results between these two groups (P>0.05). Conclusions Three dimensional conformal radiation therapy possesses similar treatment and cosmetic re- sults to conventional radiotherapy after conservative surgery for early breast cancer. But the former, one can markedly reduce the likely hood of radiation complications.