乳腺癌保乳术后不同放疗方式的疗效及不良反应

目的:回顾性分析早期乳腺癌保乳术后不同放疗方式对局部正常器官的影响，观察不同放疗方式与生存率的关系。方法:收集我院1998-2010年保乳术后接受不同放疗方式治疗的乳腺癌患者121例，其中37例接受常规二维放疗，80例接受三维放射治疗，放疗采用6MV-X线全乳腺放疗50Gy，瘤床电子线外照射加量10Gy或同步加量至60Gy，4例未接受放疗，雌、孕激素受体阳性的患者加用内分泌治疗。治疗结束后每三个月复查至2年，每半年复查至5年，以后每年复查，放射性不良反应按照RTOG评价标准进行评价。结果:全组3年生存率为97.0％，5年生存率为95.0％，5年无瘤生存率为95.0％，局部复发率为0％。二维放疗放射性肺损伤的发生率明显高于三维放疗（P=0.010）。左侧乳腺癌放射性心脏损伤发生率稍高于右侧，但无明显统计学差异（P=0.210），二维放疗放射性心脏损伤的发生率明显高于三维放疗（P=0.007）。二维放疗引起II°及III°急性放射性皮肤损伤发生率明显高于三维放疗（P=0.003）。美容效果与放射性皮肤反应相关，发生II°及以上皮肤反应的乳腺外观美容效果差于I°及以下皮肤反应的美容效果（P=0.030）。保乳术后接受局部放疗的患者3年生存率为98.0%，5年生存率为98.0%，T1与Ｔ2患者1、3、5年生存率分别为100%与97%、100%与94%、100%与94%，差异具有统计学意义（P=0.014）。结论:保乳术后行局部放疗明显延长生存时间，三维放疗与二维放疗相比5年生存优势未体现，但在保护肺、心脏、皮肤及美容效果方面明显好于二维放疗。

Side-effects and survival of different radiotherapy after breast conserving surgery for ear-ly breast cancer

Objective:To observe the effect of different radiotherapy methods for skin reactions，cosmetic effect，lung function，heart damage and survival after breast conserving surgery for early breast cancer.Methods:Collected 121 cases of breast cancer patients receiving radiotherapy in different ways after breast conserving surgery from 1998 to 2010.37 patients received conventional 2-D radiotherapy，80 patients received three dimensional radiotherapy.Radiotherapy with 6 MV-X-ray whole breast radiotherapy of 50Gy，electronic wire external irradiation dosage of 10Gy or synchronous added to 60Gy to tumor bed，estradiol or progesterone receptor positive with endocrine therapy.Results:3-year survival rate was 97.0%，5-year survival rate was 95.0%，5-year disease free survival rate was 95.0%，the local recurrence rate was 0%.The radiation-induced lung injury rate of conventional radiotherapy was significantly higher than that of 3-DCRT (P=0.010).Radiation induced heart injury rate of the left breast cancer was slightly higher than the right，but had no obvious statistical difference (P=0.21).Two-dimensional radiation radioactive heart injury was significantly higher than that in three dimensional radiotherapy，the difference was statistically significant （P=0.007).Radioactive skin injury incidence of two dimensional radiation was significantly higher than that of the three-dimensional radiotherapy，the difference was statistically significant （P=0.003).Cosmetic effect was associated with radiation skin reaction，cosmetic effect of II° and above skin reaction of breast was worse than I° (P=0.030).After breast conserving surgery received local radiotherapy 3-year survival rate was 98.0%，5-year survival rate was 98.0%，the survival rate of T1 and T2 were 100% and 97%,100% and 94%,100% and 94%，the difference was statistically significant （P=0.014）.Conclusion:The local radiotherapy after breast conserving therapy significantly prolonged survival，compared conventional radiotherapy，the 5-year survival adwantage of 3-DCRT was not reflected，but in the protection of lung，heart，skin and cosmetic result is better than conventional radiotherapy.