CAJ | 학술논문

目的观察乳腺癌保乳术+化疗后动态调强放疗的疗效和美容效果.方法 117例乳腺癌患者保乳术后先行4～6周期化疗再三维适形(6例)和动态调强放疗(111例).化疗分别采用CAF(环磷酰胺+多柔比星+氟尿嘧啶)、AC(多柔比星+环磷酰胺)、TA(紫杉醇+多柔比星)、NE(长春瑞滨+表阿霉素)、TX(紫杉醇+卡培他滨)方案.放疗采用6 MV-X线全乳腺调强放疗50Gy,瘤床电子线外照射加量10 Gy;其中68例患者锁骨上预防性照射50 Gy,42例肿块位于内侧象限的同时照射内乳淋巴引流区,锁骨上区、内乳区及胸壁均包在一个靶区里.雌、孕激素受体阳性加用内分泌治疗.治疗结束后6～12个月由2位医师评分评价美容效果.结果随访至2009年9月,随访率为94.0%,随访满3、5年者分别为114、91例.全组3生存率为99.1%,5年生存率为96%,5年无瘤生存率为88%,局部复发率为3.6%,美容效果满意者为100%.放疗中及放疗结束后未出现明显放射性心肺等重要脏器损伤.结论乳腺保乳术+化疗后胸壁动态调强放疗使靶区得到更均匀照射,有望提高局部控制率和生存率并降低正常组织并发症、肿瘤复发率.
목적 관찰유선암보유술+화료후동태조강방료적료효화미용효과.방법 117례유선암환자보유술후선행4～6주기화료재삼유괄형(6례)화동태조강방료(111례).화료분별채용CAF(배린선알+다유비성+불뇨밀정)、AC(다유비성+배린선알)、TA(자삼순+다유비성)、NE(장춘서빈+표아매소)、TX(자삼순+잡배타빈)방안.방료채용6 MV-X선전유선조강방료50Gy,류상전자선외조사가량10 Gy;기중68례환자쇄골상예방성조사50 Gy,42례종괴위우내측상한적동시조사내유림파인류구,쇄골상구、내유구급흉벽균포재일개파구리.자、잉격소수체양성가용내분비치료.치료결속후6～12개월유2위의사평분평개미용효과.결과 수방지2009년9월,수방솔위94.0%,수방만3、5년자분별위114、91례.전조3생존솔위99.1%,5년생존솔위96%,5년무류생존솔위88%,국부복발솔위3.6%,미용효과만의자위100%.방료중급방료결속후미출현명현방사성심폐등중요장기손상.결론 유선보유술+화료후흉벽동태조강방료사파구득도경균균조사,유망제고국부공제솔화생존솔병강저정상조직병발증、종류복발솔.
Objective To analyze the efficacy and cosmetic results of intensity modulate radiation therapy (IMRT) for breast cancer after breast-conserving surgery.Methods From 2003 to 2006, 117 patients with breast cancer, after breast-conserving surgery followed by 4 - 6 cycles of chemotherapy,received intensity modulated radiotherapy (IMRT) or three-dimensional conformal radiotherapy (3DCRT).The radiation dose was 50 Gy in 25 fractions to the whole breast and 10 Gy boost to the tumor bed.Patients with positive hormone receptors then received endocrine treatment.Results The follow-up rate was 94.0% until September 2009.114 and 91 patients were followed up to 3 and 5 years, respectively.The 3-and 5-year overall survival rates were 99.1% and 96%.The 5-year disease free survival and local recurrence rates were 88% and 3.6%.Cosmetic results were satisfied.Severe radiation toxicities, such as radiation pneumonitis, pulmonary fibrosis and heart injury were not found.Conclusions Patients treated with IMRT after breast-conserving surgery have a satisfied prognosis as well as cosmetic results.