早期乳腺癌保乳术后瘤床同步整合与瘤床后程补量IMRT研究

doi:10.3760/cma.j.cn113030-20191212-00515

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摘要目的比较早期乳腺癌保乳术后瘤床同步补量IMRT (SIB-IMRT)与瘤床后程补量IMRT (LB-IMRT)在放射损伤及疗效方面的差异性。方法选择2002-2012年间在山东省肿瘤医院行早期乳腺癌保乳术后IMRT的患者353例,其中218例接受SIB-IMRT,135例接受LB-IMRT。SIB-IMRT组处方剂量为瘤床(PTVt)2.15~2.3Gy 27~28次和乳腺(PTVb)1.8~1.9Gy ,27~28次;LB-IMRT组处方剂量PTVb为2.0Gy 25次,后续PTVt补量2.0Gy ,5~8次。结果中位随访期92个月。SIB-IMRT组与LB-IMRT组的美容效果优、良、一般、差者分别为10.1%、85.8%、3.7%、0.5%和12.6%、80.7%、5.2%、0.7%(P=0.731)。SIB-IMRT组和LB-IMRT组5年局部区域复发率(LRR)分别为3.21%和5.93%,10年LRR分别为4.13%和6.67%(P=0.209、0.280)。SIB-IMRT组和LB-IMRT组3、5、8、10年总生存率分别为97.7%、96.3%、94.9%、93.6%和97.8%、95.2%、92.0%、90.3%(P=0.288)。SIB-IMRT组和LB-IMRT组3、5、8、10年无瘤生存率分别为95.4%、91.8%、89.9%、89.0%和93.8%、87.7%、84.1%、82.1%(P=0.160)。结论保乳术后瘤床SIB-IMRT与LB-IMRT在美容效果、局控率、生存率等方面均相近,是安全可行的治疗方法。

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	徐敏
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	李建彬

关键词 ：乳腺肿瘤/术后放射疗法, 放射疗法,调强, 放射疗法,瘤床同步整合补量, 放射疗法,瘤床后程补量, 美容效果, 预后

Abstract：Subject To compare the irradiation-induced injury and clinical efficacy between SIB-IMRT and LB-IMRT for early-stage breast cancer after breast-conserving surgery. Methods From November 2002 to February 2012, 353 early breast cancer patients who underwent IMRT after breast-preserving surgery at Shandong Cancer Hospital were selected, of whom 218 patients receiving SIB-IMRT and 135 patients receiving LB-IMRT.The prescription dose of the SIB-IMRT group was the ipsilateral breast (PTVb )1.8-1.9 Gy, 27-28 times, and concurrent tumor bed (PTVt) 2.15-2.3 Gy, 27-28 times. In the LB-IMRT group, the prescription dose was PTVb 2.0 Gy, 25 times, followed by PTVt boost 2.0 Gy, 5-8 times. Results The median follow-up time was 92 months. The excellent, good, fair, and poor cosmetic results in the SIB-IMRT and LB-IMRT groups were 10.1% and 12.6%, 85.8% and 80.7%, 3.7% and 5.2%, 0.5%, and 0.7%, respectively (P=0.731). The 5-year locoregional recurrence rates (LRRs) in the SIB-IMRT and LB-IMRT groups were 3.21% and 5.93% and the 10-year LRRs were 4.13% and 6.67%, respectively (P=0.209, 0.280). The 3-, 5-, 8-, and 10-year overall survival rate in the SIB-IMRT and LB-IMRT groups were 97.7% and 97.8%, 96.3% and 95.2%, 94.9% and 92.0%, 93.6% and 90.3%, respectively (P=0.288). The 3-, 5-, 8-, and 10-year disease-free survival in the SIB-IMRT and LB-IMRT groups were 95.4% and 93.8%, 91.8% and 87.7%, 89.9% and 84.1%, 89.0% and 82.1%, respectively (P=0.160). Conclusion There is no significant difference in the cosmetic effect, local control rate, and survival rate between SIB-IMRT and LB-IMRT after breast-preserving surgery in patients with early-stage breast cancer. SIB-IMRT is a safe and feasible treatment.

Key words： Breast neoplasm/postoperative radiotherapy Radiotherapy, intensity-modulated Radiotherapy, simultaneous integrated boost Radiotherapy, late-course boost Cosmetic effect Prognosis

收稿日期: 2019-12-12

通讯作者: 李建彬,Emai:lijianbin0708@126.com

引用本文:

徐敏,王素贞,王玮等. 早期乳腺癌保乳术后瘤床同步整合与瘤床后程补量IMRT研究[J]. 中华放射肿瘤学杂志, 2020, 29(11): 948-953.

Xu Min,Wang Suzhen,Wang Wei et al. Comparison of clinical efficacy between simultaneous integrated boostintensity-modulated radiotherapy (SIB-IMRT) and late-course boost intensity-modulated radiotherapy (LB-IMRT) for early-stage breast cancer after breast-conserving surgery[J]. Chinese Journal of Radiation Oncology, 2020, 29(11): 948-953.

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