国际肿瘤学杂志

国际肿瘤学杂志 ›› 2019, Vol. 46 ›› Issue (6): 331-336.doi: 10.3760/cma.j.issn.1673-422X.2019.06.003

• 论著 • 上一篇    下一篇

早期乳腺癌保乳术后大分割放疗的临床观察

郑林晶1,2杨东2胡兵1,3董银萍1,3孙力军2夏重升2李宝生3黄伟3   

  1. 1济南大学 山东省医学科学院医学与生命科学学院250200； 2济宁医学院附属医院肿瘤科272100； 3山东大学附属山东省肿瘤医院放疗科，济南250117
  • 出版日期:2019-06-08 发布日期:2019-07-11
  • 通讯作者: 黄伟，Email: alvinbird@163.com E-mail:alvinbird@163.com
  • 基金资助:

    国家自然科学基金（81530060、81773232）；泰山学者建设工程（ts20120505）

Clinical observation of earlystage breast cancer after breastconserving surgery with hypofractionated radiotherapy

Zheng Linjing1,2, Yang Dong2, Hu Bing1,3, Dong Yinping1,3, Sun Lijun2, Xia Chongsheng2, Li Baosheng3, Huang Wei3   

  1. 1School of Medicine and Life Sciences, University of JinanShandong Academy of Medical Sciences, Jinan 250200, China;  2Department of Oncology, Affiliated Hospital of Jining Medical University, Jining 272100, China;  3Department of Radiation Oncology, Shandong Cancer Hospital Affiliated to Shandong University, Jinan 250117, China
  • Online:2019-06-08 Published:2019-07-11
  • Contact: Huang Wei, Email: alvinbird@163.com E-mail:alvinbird@163.com
  • Supported by:

    National Natural Science Foundation of China (81530060, 81773232); Taishan Scholar Construction Project (ts20120505)

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摘要： 目的  观察早期乳腺癌保乳术后大分割全乳腺放疗（HF-WBI）的远期疗效、不良反应和美容效果。方法  收集2014年5月至2017年8月山东大学附属山东省肿瘤医院收治的206例0～Ⅱ期乳腺癌保乳术后放疗患者，按放疗分割方式分为大分割组和常规组，大分割组116例，剂量分割：全乳42.56 Gy/16次，瘤床加量9 Gy/3次或10 Gy/5次；常规组90例，剂量分割：全乳50 Gy/25次，瘤床加量10 Gy/5次。分析两组患者的2年局部复发率、2年病死率、急性不良反应、晚期不良反应及美容效果。结果  大分割组和常规组患者2年局部复发率分别为0.86%（1/116）和2.22%（2/90），差异无统计学意义(χ2=0.049,P=0.824)；两组患者2年病死率分别为0.86%（1/116）和0（0/90），差异无统计学意义（P>0.999）。大分割组和常规组急性皮炎0～1级分别有108例（93.1%）和84例（93.3%），2～3级分别有8例（6.9%）和6例（6.7%），差异无统计学意义（χ2=0.004,P=0.948）；两组患者骨髓抑制0～1级分别有97例（83.6%）和79例（87.8%），2～4级分别有19例（16.4%）和11例（12.2%），差异无统计学意义（χ2=0.704,P=0.401）；两组患者放射性肺炎1～2级分别有1例（0.9%）和3例（3.3%），未发生放射性肺炎的例数分别有115例（99.1%）和87例(96.7%)，差异无统计学意义（χ2=1.626,P=0.202）；两组患者发生1级乳房水肿各1例（0.9%，1.1%），分别有115例（99.1%）和89例（98.9%）未发生乳房水肿，差异无统计学意义（χ2=0.033,P=0.857）。大分割组和常规组晚期不良反应中皮肤色素沉着分别为5例（4.3%）和3例（3.3%），1级乳腺皮下组织纤维化各2例（1.7%、2.2%），1级肺纤维化分别为1例(0.8%)和2例(2.2%)，两组间比较差异均无统计学意义（χ2=0.000，P>0.999；χ2=0.000，P＞0.999；χ2=0.049，P=0.824）。大分割组和常规组放疗后6个月、1年、2年美容效果优良率分别为96.5%(111/115)和93.3%(84/90)、92.1%(105/114)和90.0%(81/90)、91.4%(53/58)和87.2%(41/47)，两组间差异均无统计学意义（χ2=0.526,P=0.468；χ2=0.277,P=0.599；χ2=0.476,P=0.490）。大分割组患者全程放疗时间为25 d或29 d，较常规组的40 d明显缩短。结论  保乳术后HF-WBI与常规分割全乳放疗有相似的远期疗效、急性和晚期不良反应以及美容效果，但明显缩短了治疗时间，可作为早期乳腺癌保乳术后辅助放疗的优选方案进一步推广。

关键词: 乳腺肿瘤, 放射疗法, 治疗结果

Abstract: Objective  To observe the longterm effect, adverse reaction and cosmetic outcome of early-stage breast cancer with hypofractionated whole-breast irradiation (HF-WBI) after breast-conserving surgery. Methods  A total of 206 patients with stage 0-Ⅱ breast cancer after breastconserving surgery were included in Shandong Cancer Hospital Affiliated to Shandong University from May 2014 to August 2017. According to radiotherapy fraction, patients were divided into HF-WBI group and conventional wholebreast irradiation (CF-WBI) group. In HF-WBI group, 116 patients received wholebreast radiation to 42.56 Gy in 16 fractions followed by tumor bed boost of 9 Gy in 3 fractions or 10 Gy in 5 fractions. In CF-WBI group, 90 patients received whole breast radiation to 50 Gy in 25 fractions followed by tumor bed boost of 10 Gy in 5 fractions. The 2-year local recurrence rate,  2-year  mortality rate, acute adverse reaction, late adverse reaction and cosmetic outcome of the two groups were analyzed. Results  The 2-year local recurrence rates of HF-WBI group and CF-WBI group were 0.86% (1/116) and 2.22% (2/90) respectively, and there was no significant difference between the two groups (χ2=0.049, P=0.824). The 2year mortality rates of the two groups were 0.86% (1/116) and 0 (0/90) respectively, and there was no significant difference (P>0.999). There were 108 cases (93.1%) in HF-WBI group and 84 cases (93.3%) in CF-WBI group with grade 0-1 acute dermatitis, and 8 cases (6.9%) and 6 cases (6.7%) with grade 2-3 respectively, with no statistically significant difference (χ2=0.004, P=0.948). There were 97 cases (83.6%) in HFWBI group and 79 cases (87.8%) in CFWBI group with grade 01 bone marrow suppression, and 19 cases (16.4%) and 11 cases (12.2%) with grade 2-4 respectively, with no statistically significant difference (χ2=0.704, P=0.401). In the two groups, there were 1 case (0.9%) and 3 cases (3.3%) with grade 1-2 radiation pneumonitis, and 115 cases (99.1%) and 87 cases (96.7%) with no radiation pneumonitis respectively, and the difference was not statistically significant (χ2=1.626, P=0.202). There was 1 case  (0.9%, 1.1%) with grade 1 breast edema in each group, and 115 cases (99.1%) and 89 cases (98.9%) did not occur breast edema, with no statistically significant difference (χ2=0.033, P=0.857). In the late adverse reactions, there were 5 cases (4.3%) and 3 cases (3.3%) with skin pigmentation in HFWBI group and CF-WBI group respectively. There were 2 cases (1.7%, 2.2%) with grade 1 subcutaneous tissue fibrosis in each group, and there were 1 case (0.8%) and 2 cases (2.2%) with grade 1 pulmonary fibrosis respectively. The differences between the two groups were not statistically significant （χ2=0.000, P>0.999； χ2=0.000, P＞0.999； χ2=0.049, P=0.824）. The 6month, 1-year and 2-year cosmetic outcome good rates in HF-WBI and CF-WBI group were 96.5% (111/115) and 93.3% (84/90), 92.1% (105/114) and 90.0% (81/90), 91.4% (53/58) and 87.2% (41/47) respectively. The differences between the two groups were not statistically significant (χ2=0.526, P=0.468;  χ2=0.277, P=0.599;   χ2=0.476, P=0.490). The whole course of radiotherapy time in HF-WBI group was 25 days or 29 days, which was significantly shorter than the 40 days of CF-WBI group. Conclusion  HF-WBI after breastconserving surgery has the similar longterm effect, acute and late adverse reaction and cosmetic outcome compared with CF-WBI, and the treatment time is significantly shorter. It can be further promoted as the optimal adjuvant radiotherapy for earlystage breast cancer after breastconserving surgery.

Key words: Breast neoplasms, Radiotherapy, Treatment outcome