早期乳腺癌保乳术后瘤床同步加量短疗程放疗临床观察

目的 探讨早期乳腺癌保乳术后瘤床同步加量短疗程放疗疗效、不良反应以及美容效果。方法 2008—2010年本院收治早期乳腺癌保乳术后患者 306例,其中 160例行常规分割放疗(常规组),两野切线全乳照射,后续瘤床电子线推量,总疗程 46~48 d;146例行短疗程放疗(短程组),两野切线全乳照射,同步瘤床电子线推量,总疗程 30~32 d。Kaplan-Meier法计算生存率和局部复发率并Logrank检验差异,χ²检验两组资料可比性、不良反应及美容效果。结果 中位随访时间26个月,随访率为100%。两组1、2、3年生存率均为100%,均无局部复发(χ²=0.00,P=1.000)。常规组与短程组1、2级急性皮肤反应发生率分别为46.9%与45.1%(χ²=0.73,P=0.695)、16.3%与13.7%(χ²=0.73,P=0.695),1级皮肤及皮下组织晚期反应发生率分别为16.9%与17.1%(χ²=0.00,P=0.954);1级中性粒细胞减少发生率分别为11.9%与13.7%(χ²=0.23,P=0.633);美容优良率分别为66.2%与65.5%(χ²=0.01,P=0.927)。结论 保乳术后全乳放疗同步瘤床加量的短疗程方案与常规放疗的疗效相似,美容效果相当且未加重皮肤反应,但还需进一步研究。

Clinical outcome of early stage breast cancer treated with short-course radiotherapy with concomitant tumor bed boost after breast conserving surgery

Objective To investigate the efficacy, toxicity and cosmetic outcome of short-course radiotherapy with concomitant tumor bed boost after breast-conserving surgery for early stage breast cancer. Methods A total of 306 patients with T_1－2N_0－1M₀ breast cancer after breast-conserving surgery were included. 160 patients received whole-breast radiation to 45 Gy in 25 fractions followed by tumor bed boost of 14 Gy in 7 fractions (C group). 146 patients received whole-breast radiation to 46 Gy in 23 fractions with concomitant tumor bed boost to 60 Gy in 23 fractions (S group). Kaplan-Meier method was used to calculate the local recurrence and overall survival rates and the differences were compared by Logrank test. Chi-square test was used to compared the differences of the clinical characteristics, toxicity and cosmetic outcome between the two groups. Results The follow-up rate was 100%. After a median follow up of 26 months, the 1-, 2-and 3-year overall survival rates were 100%. No patient developed local recurrence. In C and S group, the incidence of grade 1 acute skin toxicity was 46.9% and 45.1%(χ²=0.73,P=0.695), grade 2 was 16.3% and 13.7%(χ²=0.73,P=0.695).Grade 1 late skin and subcutaneous tissue toxicity developed in 16.9% and 17.1% of patients in C and S group (χ²=0.00,P=0.954). Grade 1 neutropenia occurred in 11.9% and 13.7% of patients in C and S group (χ²=0.23,P=0.633). In C and S group, 66.2% and 65.5% of patients had excellent and good cosmetic outcome (χ²=0.01,P=0.927). Conclusions Short-course radiotherapy with concomitant tumor bed boost provides similar results to conventional radiotherapy in local control, toxicity and cosmetic outcome. Long-term follow up is warranted to confirm this finding.