早期乳腺癌保乳术后大分割调强放疗美容效果的临床研究

目的：观察早期乳腺癌保乳术后大分割调强放疗（ h-IMRT）的美容效果。方法收集潍坊市人民医院2009年2月～2013年1月67例女性早期乳腺癌保乳术后患者，根据患者意愿入组三维适形放疗（3DCRT）、常规分割调强放疗（IMRT）或h-IMRT组。3DCRT组：采用6MV-X线切线野照射，全乳腺50Gy/25次/5周，然后行瘤床区9/12 MeV电子线补量10 Gy/5 F/1周；IMRT组：采用逆向动态调强技术，全乳腺50 Gy/25次/5周，瘤床区用X线同步加量60Gy/25次/5周，或全乳腺放疗结束后行电子线补量（方式及剂量同3DCRT）；h-IM-RT组：全乳腺42．5Gy/16F/22d，瘤床区同步加量48Gy/16F/22d。结果短期随访结果示，早期乳腺癌保乳术后患者大分割调强放疗组可以明显缩短放疗时间，未降低美容效果，未增加局部复发风险。结论大分割IMRT很有可能成为中国女性早期乳腺癌保乳术后安全有效的放疗模式。

Results of Clinical Studies on Hypofractionation Intensity-Modulated Radiotherapy in Patients with Early-Stage Breast Cancer after Breast-Conserving Surgery

Objective To observe short-term cosmetic outcome of hypofractionated intensity-modulated ra-diotherapy （ h-IMRT） in patients with early-stage breast cancer after breast-conserving surgery .Methods Sixty-seven women cases with early-stage breast cancer after breast-conserving were collected in Weifang People＇s Hospital from Feb-ruary 2009 to January 2013,and divided into three group：three-dimensional conformal radiotherapy （3DCRT）,the con-ventional fractioned intensity modulated radiotherapy （ IMRT） ,and the hypofractionated intensity-modulated radiotherapy （h-IMRT） according to the patient＇s attention.For 3DCRT and IMRT group,the whole affected-side breast was delivered 5 days a week to a dose of 50 Gy in 25 fractions using 6 MV photons adopting tangential field irradiation or reverse dy-namic intensity modulated technology respectively , then tumor bed （ the lumpectomy site with a 1 ~2 cm margin or the breast scars with a 2~3cm margin） was boosted by 9/12MeV electron beam to a dose of 10Gy 5 days a week in 5 frac-tions or was done concomitantly using 6 MV photons to a dose of 10 Gy in 25 fractions for IMRT group;For h-IMRT group：the whole breast was delivered 5 days a week to a dose of 42.5Gy in 16 fractions using 6 MV photons adopting re-verse dynamic intensity modulated technology ,concomitant boost to the tumor bed was delivered to a total dose of 48Gy in 16 fractions.Results Short-term follow-up results indicated radiotherapy course was significantly shortened in h-IM-RT group,the risk of local recurrence were not increased ,cosmetic outcome was retained .Conclusion It is a possibility to treat Chinese women with early-stage breast cancer after breast-conserving surgery adopting h-IMRT technology safely and effectively .