[an error occurred while processing this directive]|[an error occurred while processing this directive]
早期乳腺癌保乳术后瘤床同步加量短疗程放疗临床观察
侯海玲, 李瑞英, 朱莉, 赵路军, 袁智勇
300060 天津市肿瘤防治重点实验室天津市肺癌诊疗中心天津医科大学附属肿瘤医院放疗科
Clinical outcome of early stage breast cancer treated with short-course radiotherapy with concomitant tumor bed boost after breast conserving surgery
HOU Hai-ling, LI Rui-ying, ZHU Li, ZHAO Lu-jun, YUAN Zhi-yong
Department of Radiation Oncology, Cancer Hospital, Tianjin Medical University, Tianjin Lung Cancer Center, Key Laboratory of Cancer Prevention and Therapy, Tianjin 300060, China
Abstract：Objective To investigate the efficacy, toxicity and cosmetic outcome of short-course radiotherapy with concomitant tumor bed boost after breast-conserving surgery for early stage breast cancer. Methods A total of 306 patients with T1－2N0－1M0 breast cancer after breast-conserving surgery were included. 160 patients received whole-breast radiation to 45 Gy in 25 fractions followed by tumor bed boost of 14 Gy in 7 fractions (C group). 146 patients received whole-breast radiation to 46 Gy in 23 fractions with concomitant tumor bed boost to 60 Gy in 23 fractions (S group). Kaplan-Meier method was used to calculate the local recurrence and overall survival rates and the differences were compared by Logrank test. Chi-square test was used to compared the differences of the clinical characteristics, toxicity and cosmetic outcome between the two groups. Results The follow-up rate was 100%. After a median follow up of 26 months, the 1-, 2-and 3-year overall survival rates were 100%. No patient developed local recurrence. In C and S group, the incidence of grade 1 acute skin toxicity was 46.9% and 45.1%(χ2=0.73,P=0.695), grade 2 was 16.3% and 13.7%(χ2=0.73,P=0.695).Grade 1 late skin and subcutaneous tissue toxicity developed in 16.9% and 17.1% of patients in C and S group (χ2=0.00,P=0.954). Grade 1 neutropenia occurred in 11.9% and 13.7% of patients in C and S group (χ2=0.23,P=0.633). In C and S group, 66.2% and 65.5% of patients had excellent and good cosmetic outcome (χ2=0.01,P=0.927). Conclusions Short-course radiotherapy with concomitant tumor bed boost provides similar results to conventional radiotherapy in local control, toxicity and cosmetic outcome. Long-term follow up is warranted to confirm this finding.
HOU Hai-ling,LI Rui-ying,ZHU Li et al. Clinical outcome of early stage breast cancer treated with short-course radiotherapy with concomitant tumor bed boost after breast conserving surgery[J]. Chinese Journal of Radiation Oncology, 2012, 21(6): 526-528.
[1] Keating NL, Landrum MB, Brooks JM, et al. Outcomes following local therapy for early-stage breast cancer in non-trial populations. Breast Cancer Res Treat,2011,125:803-813. [2] Bartelink H, Horiot JC, Poortmans P, et al. Recurrence rates after treatment of breast cancer with standard radiotherapy with or without additional radiation. N Engl J Med,2001,345:1378-1387. [3] 王淑莲.早期乳腺癌保乳术后的放疗时机.癌症进展,2008,6:259-264. [4] 俞星明,崔建国,夏群.早期乳腺癌保乳术后放疗加后装插植治疗疗效及美容效果观察.中外医疗,2010,(7):54-55. [5] Hall EJ．Time, dose and fractionation in radiotherapy//Hall EJ．Radiobiology for the radiologist．Philadelphia:Lippincott Williams ＆ Willkins,2000:4O9-415． [6] Blockhuys S, Vanhoecke B, Paelinck L, et al．Development of in vitro models for investigating spatially fractionated irradiation:physics and biological results. Phys Med Biol,2009,54:1565-1578. [7] 余子豪,王淑莲,吴君心,等.早期乳腺癌根治术后辅助放射治疗的研究//孙燕,马军.中国临床肿瘤学教育专辑(2006).北京:中国协和医科大学出版社,2006:384-388. [8] Whelan T, MacKen Z, Julian J, et al．Randomized trial of breast irradiation schedules after lumpectomy for women with lymph node negative breast cancer．J Natl Caner Inst,2002,94:1143-1150． [9] Whelan TJ, Pignol JP, Levine MN, et al．Long-term results of
hypofractionated radiation therapy for breast cancer. N Engl J Med,2010,362:513-520. [10] Sartor CI, Tepper JE．Is less more? Lessons in radiation schedules in breast cancer．J Natl Caner Ints,2002,94:1114-1115. [11] Hopwood P, Haviland JS, Sumo G, et al．The UK standardisation of breast radiotherapy (START) trial A of radiotherapy hypofractionation for treatment of early breast cancer:a randomised trial. Lancet Oncol,2008,9:331-341. [12] Hopwood P, Haviland JS, Sumo G, et al．The UK standardisation of breast radiotherapy (START) trial B of radiotherapy hypofractionation for treatment of early breast cancer:a randomised trial. Lancet,2008,371:1098-1107. [13] Hopwood P, Haviland JS, Sumo G, et al．Comparison of patient-reported breast, arm, and shoulder symptoms and body image after radiotherapy for early breast cancer:5-year follow-up in the randomised standardisation of breast radiotherapy (START) trials. Lancet Oncol,2010,11:231-240. [14] Teh AY, Walsh L, Purdie TG,et al．Concomitant intensity modulated boost during whole breast hypofractionated radiotherapy-a feasibility and toxicity study. Radiother Oncol,2012,102:89-95. [15] 吴君心,惠周光,李晔雄,等.早期乳腺癌根治术后不同剂量分割方案的放射治疗.中华肿瘤杂志,2003,25:285-288.
2012, Vol. 21 
