乳腺癌保乳术后同步加量调强放疗的临床疗效

目的:探讨乳腺癌保乳术后同步加量调强放疗的疗效、不良反应及美容效果。方法:2008年~2010年收治乳腺癌保乳术后患者78例，其中38例行瘤床同步加量调强放疗（A组），剂量分割方案为全乳50Gy/25次（2Gy/次）,瘤床同步加量至60Gy/25次（2.4Gy/次），总疗程33~35天；40例行常规分割调强放疗（B组），剂量分割方案为全乳50Gy/25次,后续瘤床推量10Gy/5次（2Gy/次），总疗程40~42天。应用Kaplan-Meier法生存分析，Log-rank法检验差异。结果:中位随访时间为73个月，随访率为100%。两组5年总生存率均为100%。A组和B组5年局部无复发生存率、无病生存率分别为97.4%、97.5%（P=0.978）；97.4%、95.0%（P=0.589)。A组和B组1、2级急性皮肤反应发生率分别为57.9%、52.5%(P＝0.632)； 13.2%、12.5%(P＝0.931)；A组和B组的1级皮肤及皮下组织晚期反应发生率分别为15.8%、15.0%（P=0.932）；1级白细胞减少发生率分别为7.9%、10.0%（P=0.745）。A组和B组在放疗前、放疗后3、5年美容效果优良率分别为86.8%、87.5%（P=0.931）；84.2%、85.0%（P=0.932）;81.6%、82.5%（P=0.916）。结论:保乳术后同步加量调强放疗的疗效与常规分割调强放疗相似，美容效果及不良反应相当。

Clinical effect of intensity-modulated radiotherapy with integrated boost after breast conservative surgery in breast cancer patients

Objective:To investigate the efficacy,toxicity and cosmetic outcome of intensity modulated radiotherapy(IMRT) with integrated boost after breast conservative surgery in breast cancer patients.Methods:A total of 78 patiens with breast cancer after breast conservative surgery were included,38 patients received whole-breast IMRT with integrated tumor bed boost(group A),a total dose of 50Gy in 25 fractions with 2Gy per fraction was delivered to the whole breast，while 60Gy with 2.4Gy per fraction was delivered to the tumor bed concomitantly，the overall treatment time were 33~35 days.40 patients received whole-breast IMRT to 50Gy in 25 fractions followed by tumor bed boost of 10Gy in 5 fractions(group B)， 2Gy per fraction,the overall treatment were 40~42 days.Kaplan-Meier method was used to calculate survival rates,the differences were compared by Log-rank test.Results:The median following-up time were 73 months,follow-up rate was 100%.5-year overall survival rates were 100% in both groups.5-year local recurrence-free survival rates,disease -free survival rates in groups A and B were 97.4%，97.5%（P=0.978）;97.4%，95.0%（P=0.589).The acute skin toxicity developed in group A and B (grade 1,2 ) were 57.9% and 52.5%(P＝0.632);13.2% and 12.5%(P＝0.931);The late skin and subcutaneous tissue toxicity developed in groups A and B of grade 1 were 15.8% and 15.0%（P=0.932）.The neutropenia developed in groups A and B of grade 1 were 7.9% and 10.0%(P=0.745).Before radiotherapy,after radiotherapy 3- year,5-year excellent and good rates of cosmetic outcome of patients in group A and B were 86.8% and 87.5%（P=0.931）；84.2% and 85.0%（P=0.932）;81.6% and 82.5%（P=0.916）.Conclusion:IMRT with integrated boost after breast conservative surgery for breast cancer patients provides similar results to conventional IMRT in survival rate,cosmetic outcome and toxicity.