乳腺癌改良根治术后大分割放疗与常规分割放疗毒性比较
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摘要
目的:探讨常规分割放疗与大分割放疗应用于乳腺癌改良根治术后的不良反应情况。方法:选取60例在本院行乳腺癌改良根治术的患者,入院时间为2016年1月-2017年12月期间,按照随机数字表法分为对照组与观察组,每组各30例。对照组采取常规分割放疗,观察组采取大分割放疗,对患者随访12个月,观察比较两组患者的近期疗效及毒性反应。结果:对患者均随访12个月,两组局部复发率、远地转移率、12个月生存率比较,差异均无统计学意义(P>0.05)。本组患者急性皮肤反应(1～2级放射性损伤)有16例,声嘶10例,放疗引起白细胞减少等血液毒性反应4例,超过半年以上的晚期损伤,包括2级以上放射性肺损伤、皮肤溃疡形成、臂丛损伤等两组患者均未出现,仅有5例患者复查胸部CT提示肺部炎症性改变较前增多,两组急性和晚期损伤比较差异均无统计学意义(P>0.05)。结论:大分割放射治疗的短期生存率及局部复发率与常规分割放射治疗相当,两者放疗后毒副作用比较无明显差异,可考虑替代常规分割放疗在临床上推广。
Objective:To investigate the adverse reactions of conventional and macroscopic fractionation radiotherapy after modified radical mastectomy for breast cancer.Method:60 cases with breast cancer modified radical in our hospital from January 2016 to December 2017 were selected,they were divided into two groups according the randomly number table,30 cases in each group.The control group adopt standard segmentation radiation,the observation group was given big radiation therapy.The patients were followed up for 12 months,the recent curative effect and toxic effects were observed and compared.Result:All patients were followed up for 12 months,and there were no significant differences between the two groups in terms of local recurrence and distant metastasis(P>0.05),and there was no significant difference in the12-month survival rate between the two groups(P>0.05).The patients with acute skin reaction(1-2 levels of radioactive damage)in 16 cases,10 cases of hearing,radiotherapy leukopenia caused by blood toxicity reaction in 4 cases,more than half a year late damage,including more than 2 level of radioactive lung injury,skin ulceration,brachial plexus injury such as two groups of patients did not appear,only five were prompt review of chest CT in patients with pulmonary inflammatory change from the previous increase,acute and late injury compared the two groups have no obvious difference(P>0.05).Conclusion:Divided radiotherapy short-term survival rate and local recurrence rate and conventional radiotherapy,segmentation both side effects after treatment was no significant difference,can consider to replace the conventional segmentation radiation therapy in clinical promotion.
Objective:To investigate the adverse reactions of conventional and macroscopic fractionation radiotherapy after modified radical mastectomy for breast cancer.Method:60 cases with breast cancer modified radical in our hospital from January 2016 to December 2017 were selected,they were divided into two groups according the randomly number table,30 cases in each group.The control group adopt standard segmentation radiation,the observation group was given big radiation therapy.The patients were followed up for 12 months,the recent curative effect and toxic effects were observed and compared.Result:All patients were followed up for 12 months,and there were no significant differences between the two groups in terms of local recurrence and distant metastasis(P>0.05),and there was no significant difference in the12-month survival rate between the two groups(P>0.05).The patients with acute skin reaction(1-2 levels of radioactive damage)in 16 cases,10 cases of hearing,radiotherapy leukopenia caused by blood toxicity reaction in 4 cases,more than half a year late damage,including more than 2 level of radioactive lung injury,skin ulceration,brachial plexus injury such as two groups of patients did not appear,only five were prompt review of chest CT in patients with pulmonary inflammatory change from the previous increase,acute and late injury compared the two groups have no obvious difference(P>0.05).Conclusion:Divided radiotherapy short-term survival rate and local recurrence rate and conventional radiotherapy,segmentation both side effects after treatment was no significant difference,can consider to replace the conventional segmentation radiation therapy in clinical promotion.
引文
[1]李帅,王淑莲,唐玉,等.78例乳腺癌改良根治术后pT3N0M0期患者放疗价值探讨[J].中华放射肿瘤学杂志,2017,26(10):1151-1155.
[2]吴涛,王淑莲,金晶,等.放疗显著改善T1~2N1M0期三阴乳腺癌改良根治术后的局部区域控制[J].中华放射肿瘤学杂志,2014,23(2):87-91.
[3]陈诚,黄蕾,何侠,等.左侧乳腺癌根治术后调强放疗两种勾画指南的比较研究[J].肿瘤学杂志,2015,21(12):978-981.
[4]王升晔,杜向慧,白雪,等.左侧乳腺癌改良根治术后切线野放疗中心脏最大距离预测心脏剂量探讨[J].中华放射肿瘤学杂志,2015,24(2):180-183.
[5]孙丽云,沈赞.术后放疗对T1-2 N1 M0期三阴乳腺癌患者预后的影响[J].临床肿瘤学杂志,2016,21(5):431-436.
[6]王松林,潘金华,童武松,等.乳腺癌改良根治术后胸壁加锁骨野常规放疗与三维适形放疗的疗效及安全性分析[J].海南医学院学报,2017,23(4):539-541,545.
[7]滕开原,程文芳,陈娜,等.乳腺癌改良根治术后调强放疗的急性血液学毒性及对放疗实施的影响[J].医学理论与实践,2017,30(8):1169-1171.
[8]徐金济,成俊,李伟,等.左侧乳腺癌改良根治术后逆向调强放射治疗的摆位误差分析[J].中国医学物理学杂志,2013,30(5):4358-4359,4386.
[9]张秋宁,吕青芳,刘锐锋,等.乳腺癌根治术后1~3个腋淋巴结阳性的T1~T2期患者放射治疗提高生存获益的Meta分析[J].中华放射医学与防护杂志,2015,35(8):598-602.
[10]Puataweepong P,Dhanachai M,Dangprasert S,et al.Putipun PUATAWEEPONG,Mantana DHANACHAI,Somjai DANGPRASERT et al.Linac-based stereotactic radiosurgery and fractionated stereotactic radiotherapy for vestibular schwannomas:comparative observations of 139 patients treated at a single institution[J].Journal of Radiation Research:Official Organ of the Japan Radiation Research Society,2014,55(2):351-358.
[11]马自强.乳腺癌改良根治并即刻假体再造术的疗效及乳腺外形影响因素[J].安徽医药,2013,17(2):247-249.
[12]陆颖,黄海欣,杨慧,等.局部晚期乳腺癌改良根治术后多西他赛同步放化疗的放射性不良反应观察[J].中国肿瘤临床,2016,43(10):438-441.
[13]韩樱松,孙桂彬,冯瑾,等.放化疗联合生物靶向治疗对乳腺癌早期改良根治术后患者远期生存率的影响[J].实用癌症杂志,2017,32(9):1460-1463.
[14]何春雷.乳癌根治术后放化疗对乳腺癌中晚期患者机体免疫力的影响[J].现代中西医结合杂志,2013,22(21):2304-2305.
[15]荣庆林,王淑莲,唐玉,等.临床T1~3N1M0期乳腺癌新辅助化疗和改良根治术后腋窝淋巴结病理阴性患者术后放疗的价值[J].中华肿瘤杂志,2017,39(6):445-452.
[16]陆颖,黄海欣,李桂生,等.局部晚期乳腺癌改良根治术后两种辅助放化疗模式的疗效与成本效果分析[J].现代肿瘤医学,2017,25(2):209-213.
[17]郝静,林忠民,施勇,等.早期乳腺癌保乳手术与改良根治术远期临床疗效分析[J].中国妇幼保健,2013,28(31):5147-5150.
[18]谢源福,吴秀萍,卓延红,等.改良根治术后腋窝淋巴结阳性乳腺癌放疗效果与ER、PR及HER2相关性分析[J].国际肿瘤学杂志,2014,41(1):66-69.
[19]Stiebel-Kalish H,Reich E,Gal L,et al.Visual outcome in meningiomas around anterior visual pathways treated with linear accelerator fractionated stereotactic radiotherapy[J].International Journal of Radiation Oncology Biology Physics,2012,82(2):779-788.
[20]金雪瑛,段琼玉.不同剂量分割方案放射治疗在乳腺癌根治术后治疗中的应用效果比较[J].四川医学,2013,34(1):106-108.
[2]吴涛,王淑莲,金晶,等.放疗显著改善T1~2N1M0期三阴乳腺癌改良根治术后的局部区域控制[J].中华放射肿瘤学杂志,2014,23(2):87-91.
[3]陈诚,黄蕾,何侠,等.左侧乳腺癌根治术后调强放疗两种勾画指南的比较研究[J].肿瘤学杂志,2015,21(12):978-981.
[4]王升晔,杜向慧,白雪,等.左侧乳腺癌改良根治术后切线野放疗中心脏最大距离预测心脏剂量探讨[J].中华放射肿瘤学杂志,2015,24(2):180-183.
[5]孙丽云,沈赞.术后放疗对T1-2 N1 M0期三阴乳腺癌患者预后的影响[J].临床肿瘤学杂志,2016,21(5):431-436.
[6]王松林,潘金华,童武松,等.乳腺癌改良根治术后胸壁加锁骨野常规放疗与三维适形放疗的疗效及安全性分析[J].海南医学院学报,2017,23(4):539-541,545.
[7]滕开原,程文芳,陈娜,等.乳腺癌改良根治术后调强放疗的急性血液学毒性及对放疗实施的影响[J].医学理论与实践,2017,30(8):1169-1171.
[8]徐金济,成俊,李伟,等.左侧乳腺癌改良根治术后逆向调强放射治疗的摆位误差分析[J].中国医学物理学杂志,2013,30(5):4358-4359,4386.
[9]张秋宁,吕青芳,刘锐锋,等.乳腺癌根治术后1~3个腋淋巴结阳性的T1~T2期患者放射治疗提高生存获益的Meta分析[J].中华放射医学与防护杂志,2015,35(8):598-602.
[10]Puataweepong P,Dhanachai M,Dangprasert S,et al.Putipun PUATAWEEPONG,Mantana DHANACHAI,Somjai DANGPRASERT et al.Linac-based stereotactic radiosurgery and fractionated stereotactic radiotherapy for vestibular schwannomas:comparative observations of 139 patients treated at a single institution[J].Journal of Radiation Research:Official Organ of the Japan Radiation Research Society,2014,55(2):351-358.
[11]马自强.乳腺癌改良根治并即刻假体再造术的疗效及乳腺外形影响因素[J].安徽医药,2013,17(2):247-249.
[12]陆颖,黄海欣,杨慧,等.局部晚期乳腺癌改良根治术后多西他赛同步放化疗的放射性不良反应观察[J].中国肿瘤临床,2016,43(10):438-441.
[13]韩樱松,孙桂彬,冯瑾,等.放化疗联合生物靶向治疗对乳腺癌早期改良根治术后患者远期生存率的影响[J].实用癌症杂志,2017,32(9):1460-1463.
[14]何春雷.乳癌根治术后放化疗对乳腺癌中晚期患者机体免疫力的影响[J].现代中西医结合杂志,2013,22(21):2304-2305.
[15]荣庆林,王淑莲,唐玉,等.临床T1~3N1M0期乳腺癌新辅助化疗和改良根治术后腋窝淋巴结病理阴性患者术后放疗的价值[J].中华肿瘤杂志,2017,39(6):445-452.
[16]陆颖,黄海欣,李桂生,等.局部晚期乳腺癌改良根治术后两种辅助放化疗模式的疗效与成本效果分析[J].现代肿瘤医学,2017,25(2):209-213.
[17]郝静,林忠民,施勇,等.早期乳腺癌保乳手术与改良根治术远期临床疗效分析[J].中国妇幼保健,2013,28(31):5147-5150.
[18]谢源福,吴秀萍,卓延红,等.改良根治术后腋窝淋巴结阳性乳腺癌放疗效果与ER、PR及HER2相关性分析[J].国际肿瘤学杂志,2014,41(1):66-69.
[19]Stiebel-Kalish H,Reich E,Gal L,et al.Visual outcome in meningiomas around anterior visual pathways treated with linear accelerator fractionated stereotactic radiotherapy[J].International Journal of Radiation Oncology Biology Physics,2012,82(2):779-788.
[20]金雪瑛,段琼玉.不同剂量分割方案放射治疗在乳腺癌根治术后治疗中的应用效果比较[J].四川医学,2013,34(1):106-108.