早期乳腺癌保乳术后部分乳腺三维适形外照射的远期观察

摘要

目的 探讨中国女性早期乳腺癌保乳术后部分乳腺三维适形外照射的可行性、疗效及美容效果.方法 2003-2010年44例早期乳腺癌患者接受保乳术后部分乳腺外照射,其中20例ABC辅助适度深吸气下CT模拟定位,24例自由呼吸下CT模拟定位.采用4个非共面野行三维适形照射,3.40 Gy/次者39例,3.85 Gy/次者5例,照射2次/d(间隔至少6h)并连续照射5d.结果 随访时问满2、3、5年者分别为39、31、l6例.放疗结束后3个月只有l7例发生1级放射性皮炎(39％).放疗后6个月和2年乳房美容效果优良率分别为100％和95％.放疗后2、3、5年局部控制率分别为100％、99％、94％,生存率均为100％.结论 符合条件的中国女性早期乳腺癌患者保乳术后行部分乳腺外照射是可行的,急性放射反应低,可获得满意的美容效果和远期疗效.%Objective To explore the feasibility,efficacy and cosmetic effect of three-dimensional conformal external beam partial breast irradiation (EB-PBI) after breast-conserving surgery for the selected Chinese early stage breast cancer patients.Methods From June 2003 to December 2010,Forty-four early stage breast cancer patients underwent EB-PBI after breast-conserving surgery.Twenty patients had CT simulation scan in moderate deep inspiration breathing hold,and twenty-four patients in free breathing.EB-PBI was planned and delivered by three-dimensional conformal radiotherapy (3DCRT) with four noncoplanar beams.The prescribed dose was 3.40 Gy per fraction in thirty-nine patients and 3.85 Gy per fraction in five patients,twice per day at an interval of at least six hours,in five consecutive days.Results The number of patients with follow up time of 2,3 and 5 years were 39,31 and 16.Grade 1 acute radiationinduced dermatitis was observed in 17 patients (39％) at three months.Cosmesis was good or excellent in all cases at six months after radiotherapy and in 95％ cases at two years after radiotherapy.The 2-,3-and 5-year local control rates were 100％,99％ and 94％,respectively.The 2-,3-,and 5-year survival rates were all 100％ and no metastases occurred.Conclusions EB-PBI delivered by 3DCRT is feasible for selected Chinese early stage breast cancer patients after breast-conserving surgery.The cosmetic effect,local control rate and long-term survival rate are satisfactory,and acute radiation toxicity is very low.