X射线调强放疗对乳腺癌保乳术后远期生存及免疫功能影响的临床观察
|
摘要
目的分析X射线调强放疗对乳腺癌保乳术后远期生存及免疫功能的影响。方法选择254例行保乳术的乳腺癌患者分为观察组(n=147)和对照组(n=147),两组术后均采取全乳腺照射50 Gy/25次。在瘤体补量上,对照组采用电子线放疗,观察组采用X射线调强放疗,处方剂量均为10～16 Gy/5～8次。比较两组靶区及心脏、患侧肺剂量学参数,毒副反应,5年无瘤生存率,5年生存率及放疗前后的T细胞亚群水平。结果两组靶区V95%差异无统计学意义(P>0. 05);观察组V105%为(11. 26±2. 59)%、V110%为(3. 15±0. 84)%、心脏照射剂量为(3. 72±1. 16) Gy、患侧肺照射剂量为(7. 51±2. 06) Gy,对照组分别为(43. 15±3. 59)%、(11. 36±1. 16)%、(8. 54±1. 92) Gy、(11. 62±3. 78) Gy,差异有统计学意义(P<0. 05)。两组急性皮肤反应、晚期皮肤反应、骨髓抑制、放射性肺炎及放射性食管炎发生率差异均无统计学意义(P>0. 05)。观察组5年无瘤生存率为98. 55%,高于对照组的94. 16%,差异有统计学意义(P<0. 05);观察组5年生存率为95. 65%,对照组为94. 89%,差异无统计学意义(P>0. 05)。放疗后观察组CD+3、CD+4、CD+4/CD+8水平低于对照组,CD8水平高于对照组,差异均有统计学意义(P<0. 05)。结论乳腺癌保乳术后X射线调强放疗可获得更佳的无瘤生存,对免疫功能影响小,可能与瘤床靶区剂量分布均匀、减少心脏和患侧肺照射剂量有关,值得临床推广应用。
Objective To analyze the effect of intensity modulated radiotherapy( IMRT) on long-term survival and immune function after breast conserving surgery for breast cancer. Methods Two hundred and fifty-four breast-conserving breast cancer patients were divided into observation group( n = 147) and control group( n = 147). The patients were treated with whole breast irradiation 50 Gy/25 times after operation. In the supplementary radiotherapy of tumors,the control group was treated with electronic radiation,while the observation group was treated with X-ray IMRT. The prescription doses were 10-16 Gy/5-8 times. Dosimetry of target area,dosimetry of heart,dosimetry of affected lung,side effects,5-year disease-free survival rate,5-year survival rate and T cell subsets before and after radiotherapy were compared between the two groups. Results There was no significant difference in V95%of target area of the tumor bed between the two groups( P>0. 05). The V105%,V110%,cardiac irradiation dose and dose of affected side lung irradiation in observation group were( 11. 26±2. 59) %,( 3. 15±0. 84) %,( 3. 72±1. 16) Gy and( 7. 51±2. 06) Gy,which were lower than control group. The difference was significant( P<0. 05). There was no significant difference in the incidence of acute skin reaction,late skin reaction,bone marrow suppression,radiation pneumonia and radiation esophagitis between the two groups( P>0. 05). The 5-year disease-free survival rate of the observation group was 98. 55%,which was higher than 94. 16% of the control group( P<0. 05). The 5-year survival rate was 95. 65% in the observation group and 94. 89% in the control group,with no significant difference( P>0. 05). After radiotherapy,the levels of CD+3,CD+4and CD+4/CD+8in the observation group were lower than those in the control group,and the level of CD+8were higher than those in the control group( P < 0. 05). Conclusion X-ray IMRT after breast-conserving surgery for breast cancer can achieve better tumor-free survival,with little impact on immune function. It may be related to the uniform distribution of dose in the target area of the tumor bed and the reduction of radiation dose in the heart and lung of the affected side,which is worthy of clinical application.
Objective To analyze the effect of intensity modulated radiotherapy( IMRT) on long-term survival and immune function after breast conserving surgery for breast cancer. Methods Two hundred and fifty-four breast-conserving breast cancer patients were divided into observation group( n = 147) and control group( n = 147). The patients were treated with whole breast irradiation 50 Gy/25 times after operation. In the supplementary radiotherapy of tumors,the control group was treated with electronic radiation,while the observation group was treated with X-ray IMRT. The prescription doses were 10-16 Gy/5-8 times. Dosimetry of target area,dosimetry of heart,dosimetry of affected lung,side effects,5-year disease-free survival rate,5-year survival rate and T cell subsets before and after radiotherapy were compared between the two groups. Results There was no significant difference in V95%of target area of the tumor bed between the two groups( P>0. 05). The V105%,V110%,cardiac irradiation dose and dose of affected side lung irradiation in observation group were( 11. 26±2. 59) %,( 3. 15±0. 84) %,( 3. 72±1. 16) Gy and( 7. 51±2. 06) Gy,which were lower than control group. The difference was significant( P<0. 05). There was no significant difference in the incidence of acute skin reaction,late skin reaction,bone marrow suppression,radiation pneumonia and radiation esophagitis between the two groups( P>0. 05). The 5-year disease-free survival rate of the observation group was 98. 55%,which was higher than 94. 16% of the control group( P<0. 05). The 5-year survival rate was 95. 65% in the observation group and 94. 89% in the control group,with no significant difference( P>0. 05). After radiotherapy,the levels of CD+3,CD+4and CD+4/CD+8in the observation group were lower than those in the control group,and the level of CD+8were higher than those in the control group( P < 0. 05). Conclusion X-ray IMRT after breast-conserving surgery for breast cancer can achieve better tumor-free survival,with little impact on immune function. It may be related to the uniform distribution of dose in the target area of the tumor bed and the reduction of radiation dose in the heart and lung of the affected side,which is worthy of clinical application.
引文
[1]夏重升,李苗苗,范敏,等.早期乳腺癌保乳术后瘤床同步加量调强放疗的临床观察[J].中华放射医学与防护杂志,2017,37(2):119-124.
[2]郑荣辉,张秀萍,张伟军,等.乳腺癌保乳术后瘤床加量大分割放疗的效果[J].广东医学,2016,37(10):1525-1527.
[3] Eaton BR,Jiang R,Torres MA,et al. Benefit of adjuvant radiotherapy after breast-conserving therapy among elderly women with T1-T2N0 estrogen receptor-negative breast cancer[J]. Cancer,2016,122(19):3059-3068.
[4]杨昭志,俞晓立,梅欣,等.早期乳腺癌保乳术后全乳IMRT及瘤床大分割同期加量的临床Ⅱ期研究[J].中华放射肿瘤学杂志,2016,25(7):703-707.
[5]孟亚秋,徐晓帆,顾军,等.术中放疗在早期乳腺癌保乳手术中的应用[J].医学研究生学报,2017,30(5):534-536.
[6]赵彪,潘香,杨毅,等.右乳癌保乳术后瘤床同步X线和后程电子线补量调强放疗剂量学比较[J].中国医学物理学杂志,2016,33(6):576-579.
[7] Sagara Y,Freedman RA,Vazluis I,et al. Patient prognostic score and associations with survival improvement offered by radiotherapy after breast-conserving surgery for ductal carcinoma in situ:A population-based longitudinal cohort s Study[J].J Clin Oncol,2016,34(11):1190-1196.
[8]张丝媛,铁剑,于会明,等.乳腺癌保乳术后放疗瘤床二维电子线与三维调强补量的疗效比较[J].中华放射医学与防护杂志,2017,5(6):345-351.
[9]潘香,赵彪,张凯恋,等.右乳癌保乳术后无标记的瘤床不同补量模式调强放疗剂量研究[J].中国医学物理学杂志,2016,33(8):766-769.
[10]钟秋子,王智,唐玉,等.乳腺癌保乳术后放化疗顺序对患者预后的影响[J].中华肿瘤杂志,2017,39(4):308-314.
[11] Speers C,Pierce LJ. Postoperative radiotherapy after breast-conserving surgery for early-stage breast cancer:A review[J]. Jama Oncol,2016,2(8):1075-1082.
[2]郑荣辉,张秀萍,张伟军,等.乳腺癌保乳术后瘤床加量大分割放疗的效果[J].广东医学,2016,37(10):1525-1527.
[3] Eaton BR,Jiang R,Torres MA,et al. Benefit of adjuvant radiotherapy after breast-conserving therapy among elderly women with T1-T2N0 estrogen receptor-negative breast cancer[J]. Cancer,2016,122(19):3059-3068.
[4]杨昭志,俞晓立,梅欣,等.早期乳腺癌保乳术后全乳IMRT及瘤床大分割同期加量的临床Ⅱ期研究[J].中华放射肿瘤学杂志,2016,25(7):703-707.
[5]孟亚秋,徐晓帆,顾军,等.术中放疗在早期乳腺癌保乳手术中的应用[J].医学研究生学报,2017,30(5):534-536.
[6]赵彪,潘香,杨毅,等.右乳癌保乳术后瘤床同步X线和后程电子线补量调强放疗剂量学比较[J].中国医学物理学杂志,2016,33(6):576-579.
[7] Sagara Y,Freedman RA,Vazluis I,et al. Patient prognostic score and associations with survival improvement offered by radiotherapy after breast-conserving surgery for ductal carcinoma in situ:A population-based longitudinal cohort s Study[J].J Clin Oncol,2016,34(11):1190-1196.
[8]张丝媛,铁剑,于会明,等.乳腺癌保乳术后放疗瘤床二维电子线与三维调强补量的疗效比较[J].中华放射医学与防护杂志,2017,5(6):345-351.
[9]潘香,赵彪,张凯恋,等.右乳癌保乳术后无标记的瘤床不同补量模式调强放疗剂量研究[J].中国医学物理学杂志,2016,33(8):766-769.
[10]钟秋子,王智,唐玉,等.乳腺癌保乳术后放化疗顺序对患者预后的影响[J].中华肿瘤杂志,2017,39(4):308-314.
[11] Speers C,Pierce LJ. Postoperative radiotherapy after breast-conserving surgery for early-stage breast cancer:A review[J]. Jama Oncol,2016,2(8):1075-1082.