目的：比较早期乳腺癌患者保留乳房(简称保乳)手术后行全乳大分割并瘤床同步加量24 d短疗程放射治疗(简称放疗)与44 d常规分割方案的近期疗效、不良反应和美容效果。方法选择2011年1月至2011年12月天津医科大学肿瘤医院收治的保乳术后病理分期为pT1~2 N0~1 M0的早期乳腺癌患者共80例,应用随机数字表法将患者分为短疗程放疗组(40例)和常规放疗组(40例)。短疗程放疗组(简称短程组)患者行全乳两野切线放射治疗,单次剂量为2．4 Gy,共18次,总剂量为43．2 Gy,同步行瘤床电子线推量照射,单次剂量为0．4 Gy,共18次,瘤床总剂量为50．4 Gy,总疗程24 d；常规放疗组(简称常规组)患者行全乳两野切线放射治疗,单次剂量为1．8 Gy,共25次,总剂量为45．0 Gy,后续行瘤床电子线推量照射,单次剂量为2．0 Gy,共7次,瘤床总剂量为59．0 Gy,总疗程44 d。采用Kaplan-Meier法计算患者的局部复发率和生存率,用Log-rank检验比较两组间的差异,并用χ2检验比较两组间不良反应及美容效果的差异。结果中位随访时间37个月,随访率为100%。两组患者的3年生存率均为100%(χ2<0．001,P=1．000),且均无一例局部复发。短程组与常规组相比,0~1级、2级急性皮肤不良反应发生率均相似[82．5%(33/40)比77．5%(31/40),χ2=0．313,P=0．576；17．5%(7/40)比22．5%(9/40),χ2=0．313,P=0．576]；1级皮肤及皮下组织晚期不良反应发生率也相似[22．5%(9/40)与20．0%(8/40),χ2=0．075,P=0．785]；美容效果优良率也相近[67．5%(27/40)与72．5%(29/40),χ2=0．238,P=0．626]。放疗引起的血液学毒性主要表现为1~2级的中性粒细胞减少和1级血小板下降,并且短程组与常规组的发生率接近[12．5%(5/40)比10．0%(4/40),χ2=0．125,P=0．724；2．5%(1/40)比5．0%(2/40),P=1．000]。结论早期乳腺癌患者保乳术后行全乳大分割并瘤床同步加量放疗可以缩短术后放疗疗程,近期疗效好,且不影响美容效果,也不加重皮肤不良反应,但远期效果还需进行长期随访,进一步研究。
目的：比較早期乳腺癌患者保留乳房(簡稱保乳)手術後行全乳大分割併瘤床同步加量24 d短療程放射治療(簡稱放療)與44 d常規分割方案的近期療效、不良反應和美容效果。方法選擇2011年1月至2011年12月天津醫科大學腫瘤醫院收治的保乳術後病理分期為pT1~2 N0~1 M0的早期乳腺癌患者共80例,應用隨機數字錶法將患者分為短療程放療組(40例)和常規放療組(40例)。短療程放療組(簡稱短程組)患者行全乳兩野切線放射治療,單次劑量為2．4 Gy,共18次,總劑量為43．2 Gy,同步行瘤床電子線推量照射,單次劑量為0．4 Gy,共18次,瘤床總劑量為50．4 Gy,總療程24 d；常規放療組(簡稱常規組)患者行全乳兩野切線放射治療,單次劑量為1．8 Gy,共25次,總劑量為45．0 Gy,後續行瘤床電子線推量照射,單次劑量為2．0 Gy,共7次,瘤床總劑量為59．0 Gy,總療程44 d。採用Kaplan-Meier法計算患者的跼部複髮率和生存率,用Log-rank檢驗比較兩組間的差異,併用χ2檢驗比較兩組間不良反應及美容效果的差異。結果中位隨訪時間37箇月,隨訪率為100%。兩組患者的3年生存率均為100%(χ2<0．001,P=1．000),且均無一例跼部複髮。短程組與常規組相比,0~1級、2級急性皮膚不良反應髮生率均相似[82．5%(33/40)比77．5%(31/40),χ2=0．313,P=0．576；17．5%(7/40)比22．5%(9/40),χ2=0．313,P=0．576]；1級皮膚及皮下組織晚期不良反應髮生率也相似[22．5%(9/40)與20．0%(8/40),χ2=0．075,P=0．785]；美容效果優良率也相近[67．5%(27/40)與72．5%(29/40),χ2=0．238,P=0．626]。放療引起的血液學毒性主要錶現為1~2級的中性粒細胞減少和1級血小闆下降,併且短程組與常規組的髮生率接近[12．5%(5/40)比10．0%(4/40),χ2=0．125,P=0．724；2．5%(1/40)比5．0%(2/40),P=1．000]。結論早期乳腺癌患者保乳術後行全乳大分割併瘤床同步加量放療可以縮短術後放療療程,近期療效好,且不影響美容效果,也不加重皮膚不良反應,但遠期效果還需進行長期隨訪,進一步研究。
목적：비교조기유선암환자보류유방(간칭보유)수술후행전유대분할병류상동보가량24 d단료정방사치료(간칭방료)여44 d상규분할방안적근기료효、불량반응화미용효과。방법선택2011년1월지2011년12월천진의과대학종류의원수치적보유술후병리분기위pT1~2 N0~1 M0적조기유선암환자공80례,응용수궤수자표법장환자분위단료정방료조(40례)화상규방료조(40례)。단료정방료조(간칭단정조)환자행전유량야절선방사치료,단차제량위2．4 Gy,공18차,총제량위43．2 Gy,동보행류상전자선추량조사,단차제량위0．4 Gy,공18차,류상총제량위50．4 Gy,총료정24 d；상규방료조(간칭상규조)환자행전유량야절선방사치료,단차제량위1．8 Gy,공25차,총제량위45．0 Gy,후속행류상전자선추량조사,단차제량위2．0 Gy,공7차,류상총제량위59．0 Gy,총료정44 d。채용Kaplan-Meier법계산환자적국부복발솔화생존솔,용Log-rank검험비교량조간적차이,병용χ2검험비교량조간불량반응급미용효과적차이。결과중위수방시간37개월,수방솔위100%。량조환자적3년생존솔균위100%(χ2<0．001,P=1．000),차균무일례국부복발。단정조여상규조상비,0~1급、2급급성피부불량반응발생솔균상사[82．5%(33/40)비77．5%(31/40),χ2=0．313,P=0．576；17．5%(7/40)비22．5%(9/40),χ2=0．313,P=0．576]；1급피부급피하조직만기불량반응발생솔야상사[22．5%(9/40)여20．0%(8/40),χ2=0．075,P=0．785]；미용효과우량솔야상근[67．5%(27/40)여72．5%(29/40),χ2=0．238,P=0．626]。방료인기적혈액학독성주요표현위1~2급적중성립세포감소화1급혈소판하강,병차단정조여상규조적발생솔접근[12．5%(5/40)비10．0%(4/40),χ2=0．125,P=0．724；2．5%(1/40)비5．0%(2/40),P=1．000]。결론조기유선암환자보유술후행전유대분할병류상동보가량방료가이축단술후방료료정,근기료효호,차불영향미용효과,야불가중피부불량반응,단원기효과환수진행장기수방,진일보연구。
Objective To compare the short-term efficacy, adverse reaction and cosmetic outcome between whole breast irradiation of short-course ( 24 d ) hypofractionated radiotherapy with concomitant tumor bed boost and conventional regimen ( 44 d ) after breast-conserving surgery for early stage breast cancer patients. Methods A total of 80 patients with pT1-2 N0-1 M0 breast cancer treated by breast-conserving surgery in Cancer Institute and Hospital, Tianjin Medical University from January 2011 to December 2011 were divided into short-course radiotherapy group ( n=40 ) and conventional radiotherapy group ( n=40 ) using a random number table method. In short-course radiotherapy group, 40 patients received whole breast radiation of 43. 2 Gy (2. 4 Gy each fraction, 18 fractions) with concomitant tumor bed boost of 7. 2 Gy (0. 4 Gy each fraction, 18 fractions) ( total dose:50. 4 Gy, duration:24 d) . In conventional radiotherapy group, 40 patients received whole-breast radiation of 45. 0 Gy (1. 8 Gy each fraction, 25 fractions) followed by tumor bed boost of 14. 0 Gy (2. 0 Gy each fraction, 7 fractions)(total dose:59. 0 Gy, duration:44 d) . Kaplan-Meier method was used to calculate the local recurrence and overall survival, and the differences between two groups were analyzed by Log-rank test.χ2 test was used to compare the differences in adverse reaction and cosmetic outcome between the two groups. Results All patients were followed up for median 37 months, and the follow-up rate was 100%. The 3-year overall survival rates in two groups were both 100%(χ2<0. 001,P=1. 000). No patient developed local recurrence. The incidence of grade 0-1 acute adverse reaction of skin was 82. 5% ( 33/40 ) in short-course radiotherapy group and 77. 5% (31/40) in conventional radiotherapy group (χ2=0. 313,P=0. 576), and the incidence of grade 2 adverse reaction was 17. 5% ( 7/40 ) in short-course radiotherapy group and 22. 5%(9/40)in conventional radiotherapy group (χ2=0. 313,P=0. 576). The adverse reaction of skin and subcutaneous tissue in grade l developed in 22. 5% ( 9/40 ) of short-course radiotherapy group and 20%(8/40) of conventional radiotherapy group (χ2=0. 075,P=0. 785). Totally 67. 5% (27/40) of patients in short-course radiotherapy group and 72. 5% ( 29/40 ) of patients in conventional radiotherapy group had good cosmetic outcome (χ2=0. 238,P=0. 626). The radiotherapy-induced blood toxicity was mainly manifested as grade 1 to 2 neutropenia and grade 1 thrombocytopenia, the former occurred in 12. 5% (5/40) of patients in short-course radiotherapy group and 10% (4/40)of conventional radiotherapy group (χ2=0. 125,P=0. 724), and the latter occurred in 2. 5%( 1/40 ) of short-course radiotherapy group and 5% ( 2/40 ) of conventional radiotherapy group ( P=1. 000 ) . Conclusion Short-course whole breast hypofractionated radiotherapy with concomitant tumor bed boost can shorten the duration of postoperative radiotherapy, and obtain good short-term effect without affecting cosmetic effect or increasing the skin adverse reactions, however, long-term effects need to be confirmed by long-term follow-up and further study.
