瘤床加量联合三维适型放疗对早期乳腺癌保乳术后的疗效分析
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摘要
目的分析瘤床加量联合三维适型放疗对早期乳腺癌保乳术后的疗效。方法以入院病例号为编号,根据随机数字表,将2013年1月—2015年12月入院治疗的170例早期乳腺癌患者编号,以随机数字法分为2组,对照组和观察组各85例,均行保乳术治疗,术后给予两野切线全乳照射。对照组给予常规瘤床电子线推量,观察组给予瘤床加量联合三维适型放疗。对患者随访36个月,观察并比较2组靶区均匀性指数(HI)、靶区适形度指数(CI),皮肤美容效果及不良反应情况,并比较局部复发率和远处转移率。结果观察组靶区均匀性指数(HI)、靶区适形度指数(CI)优于对照组(t=8.746,P <0.001; t=8.005,P <0.001);观察组急性及晚期皮肤不良反应发生率低于对照组(χ~2=7.784,P=0.005;χ~2=5.749,P=0.016);观察组患者美容效果优于对照组,差异有统计学意义(Z=4.181,P=0.041); 2组间局部复发率和远处转移率比较差异无统计学意义(χ~2=2.024,P=0.155;χ~2=0.206,P=0.650)。结论瘤床加量联合三维适型放疗计量均匀,具有良好靶区适形度,皮肤不良反应发生率较低,具有良好美容效果,更为符合女性乳腺癌患者的美学需求。
Objective To analyze the curative effect of breast cancer combined with three dimensional conformal radiotherapy on breast conserving surgery for early breast cancer.Methods According to the number of admission cases,170 patients with early breast cancer who were admitted to hospital from January,2013 to December,2015 were divided into two groups randomly.The control group and the observation group(85 cases each) were treated with breast conserving surgery.After operation,two-field tangent whole breast irradiation was given.The control group was treated with conventional tumor bed electron line,and the observation group was treated with tumor bed volume plus three dimensional conformal radiotherapy.The patients were followed up for 36 months.The target homogeneity index(HI),target conformity index(CI),skin cosmetic effect and adverse reaction were observed and compared between the two groups.The local recurrence rate and distant metastasis rate were also compared.Results The target homogeneity index(HI) and target conformity index(CI) of the observation group were better than those of the control group(t = 8.746,P < 0.05; t =8.005,P < 0.05).No grade 3-4 skin adverse reactions occurred in the observation group,and the incidence of acute and late skin adverse reactions was lower than that in the control group(χ~2= 7.784,P < 0.05; χ~2= 5.749,P < 0.05).The excellent and good rate of cosmetic effect in the observation group was higher than that in the control group,with statistical significance(Z = 4.181,P < 0.05).There was no significant difference in the local recurrence rate and distant metastasis rate between the two groups(χ~2= 2.024,P > 0.05; χ~2= 0.206,P > 0.05;).Conclusion Tumor bed dosage combined with three-dimensional conformal radiotherapy has a uniform measurement,a good target conformity,a low incidence of skin adverse reactions,a good cosmetic effect,more in line with the aesthetic needs of women with breast cancer.
Objective To analyze the curative effect of breast cancer combined with three dimensional conformal radiotherapy on breast conserving surgery for early breast cancer.Methods According to the number of admission cases,170 patients with early breast cancer who were admitted to hospital from January,2013 to December,2015 were divided into two groups randomly.The control group and the observation group(85 cases each) were treated with breast conserving surgery.After operation,two-field tangent whole breast irradiation was given.The control group was treated with conventional tumor bed electron line,and the observation group was treated with tumor bed volume plus three dimensional conformal radiotherapy.The patients were followed up for 36 months.The target homogeneity index(HI),target conformity index(CI),skin cosmetic effect and adverse reaction were observed and compared between the two groups.The local recurrence rate and distant metastasis rate were also compared.Results The target homogeneity index(HI) and target conformity index(CI) of the observation group were better than those of the control group(t = 8.746,P < 0.05; t =8.005,P < 0.05).No grade 3-4 skin adverse reactions occurred in the observation group,and the incidence of acute and late skin adverse reactions was lower than that in the control group(χ~2= 7.784,P < 0.05; χ~2= 5.749,P < 0.05).The excellent and good rate of cosmetic effect in the observation group was higher than that in the control group,with statistical significance(Z = 4.181,P < 0.05).There was no significant difference in the local recurrence rate and distant metastasis rate between the two groups(χ~2= 2.024,P > 0.05; χ~2= 0.206,P > 0.05;).Conclusion Tumor bed dosage combined with three-dimensional conformal radiotherapy has a uniform measurement,a good target conformity,a low incidence of skin adverse reactions,a good cosmetic effect,more in line with the aesthetic needs of women with breast cancer.
引文
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[10]孙颖,张海波,阎英.乳腺癌根治术或改良根治术后辅助性放疗[J].国际肿瘤学杂志,2016,43(5):376-378.
[11]王跃辉.乳腺癌患者保乳术后行调强放疗的疗效研究[J].中国保健营养,2017,8(33):44-45.
[12]王思阳,徐西伟.乳腺癌保乳术后三维适型调强放疗疗效分析[J].医药前沿,2016,6(16):224-225.
[13]张芹.早期乳腺癌保乳术后大分割放疗的研究进展[J].实用肿瘤杂志,2017,32(4):296-299.
[14]Jia MM,Hang ZJ,Chen Q,et al.Effects of postmastectomy radio therapy on prognosis in different tumor stages of breast cancer patients with positive axillary lymph nodes[J].Cancer Biol Med,2014,5(11):123-129.
[15]Haviland JS,Owen JR,Dewar JA,et al.The UK Standardisation of Breast Radiother-apy(START)trials of radiotherapy hypofractionation for treatment of early breast cancer:10-year follow-up results of two randomised controlled trials[J].Lancet Oncol,2013,14(11):1086-1094.
[16]任晔,单改仙,王莹,戴卓捷,崔迪,苏晓明,王宗烨.左侧乳腺癌保乳术后3种放疗技术在同步推量中的剂量学研究[J].癌症进展,2017,15(9):1032-1035,1081.
[2]令狐锐霞,司文,李莹,等.3846例乳腺癌流行病学及临床病理学分析[J].解放军医学院学报,2015,36(10):1017-1021,1038.
[3]蒋国良.现代肿瘤放射治疗学[M].上海:上海科学技术出版社,2003:546-567.
[4]殷蔚伯,余子豪,徐国镇,等.肿瘤放射治疗学[M].4版.北京:中国协和医科大学出版社,2008:1164-1189.
[5]李平,申文江,王绿化.放射治疗损伤[M].北京:中国医药科技出版社,2001:104-114.
[6]陈光新.整形保乳手术和即刻乳房再造术在早期乳腺癌的临床应用[J].中国现代普通外科进展,2017,20(12):975-977.
[7]邓军,贾建光,高愿,等.保乳手术和改良根治术治疗早期乳腺癌的临床对比研究[J].中华全科医学,2018,16(4):533-537.
[8]谢芳,倪进斌,包召玉.乳腺癌腋窝淋巴结清扫的外科手术进展[J].中华全科医学,2015,13(12):2033-2035.
[9]邓垒,惠周光,王淑莲,等.早期乳腺癌保乳术后大分割三维放疗Ⅱ期临床观察[J].中华放射肿瘤学杂志,2013,22(1):1-4.
[10]孙颖,张海波,阎英.乳腺癌根治术或改良根治术后辅助性放疗[J].国际肿瘤学杂志,2016,43(5):376-378.
[11]王跃辉.乳腺癌患者保乳术后行调强放疗的疗效研究[J].中国保健营养,2017,8(33):44-45.
[12]王思阳,徐西伟.乳腺癌保乳术后三维适型调强放疗疗效分析[J].医药前沿,2016,6(16):224-225.
[13]张芹.早期乳腺癌保乳术后大分割放疗的研究进展[J].实用肿瘤杂志,2017,32(4):296-299.
[14]Jia MM,Hang ZJ,Chen Q,et al.Effects of postmastectomy radio therapy on prognosis in different tumor stages of breast cancer patients with positive axillary lymph nodes[J].Cancer Biol Med,2014,5(11):123-129.
[15]Haviland JS,Owen JR,Dewar JA,et al.The UK Standardisation of Breast Radiother-apy(START)trials of radiotherapy hypofractionation for treatment of early breast cancer:10-year follow-up results of two randomised controlled trials[J].Lancet Oncol,2013,14(11):1086-1094.
[16]任晔,单改仙,王莹,戴卓捷,崔迪,苏晓明,王宗烨.左侧乳腺癌保乳术后3种放疗技术在同步推量中的剂量学研究[J].癌症进展,2017,15(9):1032-1035,1081.