CAJ | 학술논문

目的观察分析早期乳腺癌保乳术后全乳腺调强放疗剂量学优势、临床疗效及不良反应.方法搜集2004年10月至2005年8月收治的103例早期乳腺癌保乳术后患者,比较全乳腺逆向调强和常规切线野治疗计划靶区的均匀性和心脏、肺受照剂量,以及调强放疗临床不良反应、美容效果及疗效.结果调强放疗、常规放疗临床靶区的95%～107%处方剂量的平均体积百分比分别为95.8%±4.90%、84.O%±20.7%(t=9.60,P<0.01);同侧受照剂量>20 Gy正常肺组织占全肺体积(V20)的百分比分别为15.70%±4.64%、23.11%±7.88%(t=-13.3,P<0.01);63例左侧乳腺癌患者心脏V30分别为4.44%±3.93%、15.55%±10.89%(t=-11.3,P<0.01).1、2年美容效果优良率均为100%.1、2、3年局部控制率分别为99%、99%、98%;1、2、3年无瘤生存率分别为99%、99%、96%.放疗结束时急性皮肤反应1级98例.2级5例.结论乳腺癌保乳术后全乳腺调强与常规切线野照射相比,能明显改善靶区剂量分布、保护周围正常组织;局部疗效好,临床不良反应小.
목적 관찰분석조기유선암보유술후전유선조강방료제량학우세、림상료효급불량반응.방법 수집2004년10월지2005년8월수치적103례조기유선암보유술후환자,비교전유선역향조강화상규절선야치료계화파구적균균성화심장、폐수조제량,이급조강방료림상불량반응、미용효과급료효.결과 조강방료、상규방료림상파구적95%～107%처방제량적평균체적백분비분별위95.8%±4.90%、84.O%±20.7%(t=9.60,P<0.01);동측수조제량>20 Gy정상폐조직점전폐체적(V20)적백분비분별위15.70%±4.64%、23.11%±7.88%(t=-13.3,P<0.01);63례좌측유선암환자심장V30분별위4.44%±3.93%、15.55%±10.89%(t=-11.3,P<0.01).1、2년미용효과우량솔균위100%.1、2、3년국부공제솔분별위99%、99%、98%;1、2、3년무류생존솔분별위99%、99%、96%.방료결속시급성피부반응1급98례.2급5례.결론 유선암보유술후전유선조강여상규절선야조사상비,능명현개선파구제량분포、보호주위정상조직;국부료효호,림상불량반응소.
Objective To analyze the dosimetfic benefits, clinical effect and side-respond of whole breast using intensity modulated radiotherapy for early breast cancer after conservative surgery. Methods From Oct.2004 to Aug. 2005,103 patients received the whole breast intensity modulated radiation therapy (IMRT). A dosimetric comparison of IMRT with conventional radiotherapy (CR) was performed on each patient. The cosmetic results, clinical effect and side-respond were observed. Results The average volume proportion of 95% and 107% prescribed dose was 95.8% ± 4.90% and 84.0% ± 20.7% (t = 9.60, P < 0.01) with IMRT and CR in clinical target volume, respectively. The V20 (lung volume of aceepted> 20 Gy/all lung volume × 100%) of the ipsilateral lung were 15.70% ± 4.64% and 23. 11% ± 7.88% (t = - 13.3, P < 0.01). The V30of the heart were 4.44% ±3.93% and 15.55% ± 10.89%(t = - 11.3, P< 0.01) with IMRT and CR respectively for sixty-three left side breast cancer patients. The 1- and 2-year excellent rate of good cosmetic outcome was both 100%. The 1-, 2- and 3-year local control rate was 99% ,99% and 98% ,respectively. The 1-, 2- and 3-year disease-free survival rate was 99% ,99% and 96% ,respectively. The Grade 1 and 2 acute radiation skin reaction rate was 95.1% and 4.9%, respectively. Conclusion Compared with conventional radiotherapy, IMRT improves dose distribution of CTV and reduce the dose of normal tissue around CTV;but with better clinical effects and lower side-respond for early breast cancer patients after breast conservative surgery.