同时性双侧乳腺癌保乳术后放疗技术和近期疗效分析

doi:10.3760/cma.j.issn.1004-4221.2019.09.009

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摘要

目的探讨同时性双侧乳腺癌整体等中心切线野混合调强技术的剂量特点及疗效。方法纳入14例同时性双侧乳腺癌保乳术后双侧全乳±瘤床加量放疗患者。采用等中心切线野混合调强技术进行双乳整体放疗(50Gy分25次或43.5Gy分15次)。分析计划的覆盖度、均匀性及临床近期疗效。结果全组患者放疗计划总野数为8~11个,其中调强野为4~7个。全乳计划靶区均达95%,平均瘤床覆盖度在X线同步补量组分别为(95.54±1.33)%(左)及(94.19±1.03)%(右),在电子线序贯补量组为(90.25±8.79)%(左)及(85.28±8.35)%(右)。平均双肺V20为(16.69±3.90)%,平均心脏Dmean为5.48Gy。全组3例出现2级急性皮肤反应,无≥2级的放射性肺炎发生。中位随访至30.1个月时,11例美容效果为优,无一复发。结论双乳腺癌保乳术后采用整体等中心切线野混合调强技术安全可靠。

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	马茗微
	王淑莲
	苗俊杰
	唐玉
	赵波
	覃仕瑞
	张江鹄
	亓姝楠
	陈偲晔
	马玉超
	刘欣
	李晔雄

关键词 ：乳腺肿瘤/保乳术后放射疗法, 放疗技术, 近期疗效

Abstract：

Objective To investigate the dose characteristics and outcomes of a single isocenter bilateral tangential fields (IBTF) combined with intensity-modulated radiotherapy (IMRT) in bilateral breast radiotherapy (BBR). Methods Fourteen female patients with synchronous bilateral breast cancer (SBBC) after breast-conserving surgery (BCS) were enrolled in this study. All patients received BBR using IBTF combined with IMRT at a conventional (50Gy/25f) or hypofractionated (43.5Gy/15f) dose. For patients with invasive cancer,the additional tumor bed boost was given with sequential electron radiation or simultaneously photon IMRT. The coverage, uniformity and short-term clinical efficacy were evaluated. Results The number of the irradiation field was 8-11,including 4-7 intensity-modulated fields. The bilateral breast PTV dose coverage reached 95% in all plans. For the tumor bed, the mean dose coverage was (95.54±1.33)%(left) and (94.19±1.03)%(right) using photon, and (90.25±8.79)%(left) and (85.28±8.35)%(right) using electron. The average V20 of bilateral lungs was (16.69±3.90)%. The cardiac Dmean was 5.48 Gy. Three patients presented with grade Ⅱ acute skin toxicities. No ≥ grade Ⅱ pneumonitis was observed. No recurrence occurred with the median follow-up time of 30.1 months. Eleven patients showed excellent cosmetic results. Conclusion BBR using IBTF combined with IMRT is efficacious and safe for patients with SBBC after BCS.

Key words： Breast neoplasm/adjuvant radiotherapy Radiation technique Short-term efficacy

收稿日期: 2018-10-18

基金资助:

国家重点研发计划项目(2016YFC0904600);北京大学第一医院种子基金(2018SF043)

通讯作者: 王淑莲,Email:wsl20040118@yahoo.com;唐玉,Email:tangyu_cams@163.com

引用本文:

马茗微,王淑莲,苗俊杰等. 同时性双侧乳腺癌保乳术后放疗技术和近期疗效分析[J]. 中华放射肿瘤学杂志, 2019, 28(9): 677-681.

Ma Mingwei,Wang Shulian,Miao Junjie et al. Isocenter bilateral tangential fields combined with intensity-modulated radiotherapy for synchronous bilateral whole breast irradiation[J]. Chinese Journal of Radiation Oncology, 2019, 28(9): 677-681.

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http://journal12.magtechjournal.com/Jweb_fszlx/CN/10.3760/cma.j.issn.1004-4221.2019.09.009 或 http://journal12.magtechjournal.com/Jweb_fszlx/CN/Y2019/V28/I9/677

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