摘要：
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.%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.
