胸壁和区域淋巴引流区整体调强放疗在乳腺癌改良根治术后的应用研究北大核心

目的:评价胸壁和区域淋巴引流区整体调强放疗与分段三维适形放疗两种方法在乳腺癌改良根治术后患者中的疗效差异。方法:回顾性分析两种放疗模式在311例乳腺癌改良根治术患者中的疗效差异,采用Kaplan-Meier法计算无疾病生存(disease free survival,DFS)率及总体生存率(overall survival,OS),Cox回归分析影响预后的单因素及多因素。基于CTCAE 4.0(Common Toxicity Criteria for Adverse Events)准则评估两种放疗技术的晚期副反应差异。结果:纳入的311例患者中,有195例接受了整体调强放疗,116例接受传统三维适形放疗。整体调强放疗组和分段三维适形放疗组5年DFS分别为88.7%和78.8%(P=0.013),5年OS分别为93.8%和89.4%(P=0.280)。单因素分析显示,T、N分期、分化程度、内乳淋巴结照射及放疗方式是影响乳腺癌改良根治术后患者DFS的预后因素,T分期、分化程度是OS的预后因素。多因素分析显示,分化程度、内乳淋巴结照射及放疗方式是影响患者DFS的独立预后因素,分化程度、内乳淋巴结照射是影响患者OS的独立预后因素。两种放疗方式常见的晚期副反应无明显差异。结论:胸壁和区域淋巴引流区整体化调强放疗可降低乳腺癌改良根治术后患者的复发率,且毒副反应可耐受。

Study of integrated intensity-modulated radiotherapy of the chest wall and supraclavicular region for breast cancer after modified radical mastectomy

Objective:To evaluate the efficacy between the integrated intensity-modulated radiotherapy(IMRT) of the chest wall and supraclavicular region and the conventional segmented 3-dimensional conformal radiotherapy(3D-CRT) for breast cancer patients received modified radical mastectomy.Methods:311 patients with modified radical mastectomy were retrospectively analyzed.Kaplan-Meier method was utilized to calculate the disease free survival(DFS) rates and the overall survival(OS) rates.Cox regression analysis was performed to executing the univariate and multivariate analysis of the DFS and OS,respectively.Late side effects between the two treatment groups were accessed based on the Common Toxicity Criteria for Adverse Events(CTCAE;version 4.0).Results:In 311 patients,195 received integrated IMRT and 116 patients received segmented 3D-CRT.The 5-year DFS rates were 88.7% and 78.8% in integrated IMRT group and segmented 3D-CRT group,respectively(P=0.013).The 5-year OS rates were 93.8% and 89.4% in integrated IMRT group and segmented 3D-CRT group,respectively(P=0.280).Univariate analysis revealed that T stage,N stage,differentiation,internal mammary node irradiation and radiotherapy were the prognostic factors for DFS.T stage and differentiation were the prognostic factors for OS.Multivariate analysis demonstrated that differentiation,internal mammary node irradiation and radiotherapy were the independent prognostic factors for DFS.The differentiation,internal mammary node irradiation were the independent prognostic factors for OS.No significant difference was observed in late side-effects between the two groups.Conclusion:Intensity-modulated radiotherapy of the chest wall and supraclavicular region reduces the recurrence rate for post-mastectomy breast cancer patients with tolerable toxicities.