Objective To investigate the effects of preoperative breast magnetic resonance imaging ( MRI ) examination and postoperative three dimensional conformal radiotherapy in breast cancer patients receiving breast conserving surgery. Methods The data about 116 patients with early breast cancer who were treated in our hospital were enrolled in the study. These patients were divided into different groups according to different variables including patient's age, tumor size, tumor location and pathological features,then the detection ability by breast MRI for additional lesions of patients was analyzed and compared with that by conventional detection means. Meanwhile 16 patients who were consistent with the condition of three dimensional radiotherapy and were treated in our hospital from August 2012 to May 2015 were also enrolled in the study. The differences among radiation doses of heart and lung, distribution of volumes and doses in every patient were analyzed, moreover, the indication and dosage dominance of three dimensional radiotherapy were compared with those of conventional radiotherapy. Results The MRI detected additional finding lesions in 40 patients (34. 4% ),moreover, the additional findings were confirmed to be malignant in 25 patients (21. 6% ),which led to the changes of treatment means. MRI had a higher resolving power for soft tissues than that by molybdenum target mammography and B ultrasound examination. Moreover the lesions less than 1cm were detected in 27 patients. The breast size percentage in 16 patients treated by three dimensional conformal radiotherapy who received 50% prescription dosage was two times as high as that of patients who received 100% prescription dosage,and the percentage of PTV occupying breast size in the same side was almost the same as 95% isodose line. Conclusion Before breast conserving surgery,MRI can make up for the deficiencies of molybdenum target mammography and B ultrasound examination,which can find out additional lesions,providing a more accurate and comprehensive reference for surgery. After breast-conserving surgery, the three dimensional conformal radiotherapy has better homogeneity, which can effectively avoid radiation damage on surrounding normal tissues and reduce radiation doses on critical organs when increasing radiation doses on tumor tissues.%目的 通过术前乳腺磁共振检查及术后三维放疗在临床中的应用,分析二者对乳腺癌保乳患者综合治疗的影响.方法 回顾性分析就诊的116例早期乳腺癌患者,按年龄、肿块大小、肿块位置、病理学特征等不同变量对其进行分组,研究乳腺磁共振对早期乳腺癌患者额外病灶的探测能力,并与常规的检测方式进行对比;同时选取同期就诊的符合三维放疗条件的16例患者,分析心脏、肺受照剂量、体积和剂量分布三者之间存在的区别,同时对三维适形放疗技术的适应证与剂量优势与常规放疗进行对比.结果 磁共振成像检测出40例(34. 4% )患者有额外发现的病灶.在25例(21. 6% )的患者中,额外发现被证实是恶性的而导致治疗的变化.磁共振成像具有比钼靶和超声更高的软组织分辨能力,27例＜1 cm的病变被清楚的检测出来;通过三维放疗的16 例患者接受50%的处方剂量的患侧乳房体积百分比大约是接受100%处方剂量的2倍,PTV 占据的同侧乳腺体积的百分比和95%的等剂量线几乎是相同的.结论 乳腺癌保乳手术前,MRI 检查可以弥补钼靶摄片和B 超检查的不足,发现额外病灶,为手术提供较准确和全面的依据;乳腺癌保乳手术后,三维适形放疗匀质性较好,有效地避免了对周围正常组织的放射性损伤,在增加肿瘤辐射剂量的同时减少了危急器官的受照剂量.
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