摘要
目的观察早期乳腺癌保乳术后全乳腺调强放疗的临床毒性反应和近期疗效。方法2004年9月-2005年10月本院收治的122例早期乳腺癌接受保乳手术的患者,实施全乳腺调强放疗46Gy,瘤床电子线推量14Gy。评价乳腺靶区的剂量分布均匀性和周围正常组织的照射剂量和体积,观察临床毒性反应,美容效果及疗效。结果关于靶区剂量分布均匀性,CTV的V95%、V107%和V95%￣107%分别为(99.2±0.78)%、(3.82±6.34)%和(96.2±5.20)%。关于周围正常组织的照射,同侧肺的平均剂量和V20分别为(6.40±2.12)Gy和(15.6±4.74)%;对侧乳腺的平均剂量和V5分别为(1.29±0.79)Gy和(0.82±1.59)%。其中72例左侧乳腺癌患者心脏的平均剂量和V30分别为(3.54±2.63)Gy和(4.36±3.85)%。放疗结束时急性皮肤反应1级115例,2级7例,随访期间所有患者未观察到心脏、肺的放射性毒性反应。1年及2年美容效果优良率均为100%。1,2,3年局部控制率分别为99.2%,99.2%和98.4%,1,2,3年无瘤生存率分别为99.2%,99.2%和96.7%。结论乳腺癌保乳术后全乳腺调强靶区剂量分布均匀性好、周围正常组织照射小,临床毒性反应小,近期疗效好。
Objective To study the toxicity and curative effect of the whole breast IMRT in patients with early-stage breast cancer treated with breast-conserving surgery. Methods One hundred and twenty-two patients with early breast cancer after breast-conservative surgery were received the whole breast IMRT from Oct.2004 to Oct.2005. Prescription dose was 46 Gy for clinical target volume with 6-MV X-ray,and boost dose was 14 Gy in the tumor bed with electron. The homogeneity of the CTV and the irradiation dose and volume of lung and heart and contralateral breast were evaluated in the dose-volume histogram（ DVH ）. The clinical reaction and cosmetic results effect were observed. Results For the homogeneity of CTV,the average volume proportion of 95%, 107% and 95%-107% prescribed dose was （99.2±0.78）%,（3.82±6.34）% and 96.2±5.20%. As to normal tissue sparing in OARs,The mean dose and V20 of the ipsilateral lung were （6.40±2.12）Gy and （ 15.6±4.74% ）.The mean dose and V5 of the contralateral breast were （1.29±0.79）Gy and （0.82±1.59）%.The mean dose and V30 of the heart for seventy-two left side breast cancer patients were （3.54±2.63）Gy and （4.36±3.85）%.Grade 1 of acute radiation skin reaction was seen in 115 patients and grade 2 in 7 patients and there was not more than grade 2 of skin reaction for all the patients.The toxicity of heart and lung was not observed during the follow-up period for all the patients. Excellent or good cosmetic outcome was 100% at 1st year and 2nd year.The local control rate were 99.2%,99.2% and 98.4%. The disease-free survival rate were 99.2%, 99.2% and 96.7% at 1st year and 2nd and 3rd year. Conclusion This study suggests that the whole breast IMRT improves CTV dose distribution and improves normal tissue sparing in OARs. gains a satisfied result in both tumor control and cosmetic outcome in patients with early-stage breast cancer treated with breast-conserving surgery.
出处
《基层医学论坛》
2008年第22期673-675,共3页
The Medical Forum
关键词
乳腺癌
保乳手术
调强放射疗法
Breast cancer Breast-conservative surgery Intensity modulated radiation therapy
