协和医学杂志

2013, v.4(04) 377-382

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螺旋断层调强与固定野调强技术在全乳放疗中的近期临床效果
Early Clinical Results of Whole Breast Irradiation with Helical Tomotherapy or Fixed-field Intensity-modulated Radiation Therapy

侯晓荣;杨波;刘志凯;胡克;晏俊芳;沈晶;邱杰;张福泉;
HOU Xiao-rong;YANG Bo;LIU Zhi-kai;HU Ke;YAN Jun-fang;SHEN Jing;QIU Jie;ZHANG Fu-quan;Department of Radiation Oncology,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences &Peking Union Medical College;

摘要(Abstract):

目的研究早期乳腺癌保乳术后应用螺旋断层调强放疗(helical tomotherapy,HT)和固定野调强放疗(fixed-field intensity-modulated radiotherapy,FF-IMRT)的近期疗效和早期临床反应。方法 2012年9月至2013年3月本院使用HT(HT组)和FF-IMRT(FF-IMRT组)进行保乳术后全乳放疗的早期乳腺癌患者共24例,每组12例,术后病理分期0~ⅡB期,全乳放疗剂量46~50 Gy/23~25次。其中接受化疗者11例(45.8%),接受内分泌治疗者18例(75%)。对两组靶区及危及器官剂量分布进行评估,对放疗毒性反应及美容效果进行评价。结果与FF-IMRT组相比,HT组的计划靶区(planning target volume,PTV)105%、PTV110%高剂量区减少(P=0.000,P=0.023),靶区的均匀性和适形度改善(P=0.003,P=0.002)。患侧肺的V5、V20、Dmean(P=0.002,P=0.001,P=0.000),双肺的V5、V20、Dmean(P=0.010,P=0.002,P=0.009)及心脏的V5、V20(P=0.033,P=0.030)等受量降低。HT组出现Ⅰ、Ⅱ级放射性皮炎者分别有10例(83.3%)、2例(16.7%),FF-IMRT组出现Ⅰ、Ⅱ级放射性皮炎者分别有11例(91.7%)、1例(8.3%);所有患者均未出现放射性肺炎。HT组患者美容效果为满意者12例(100%),FF-IMRT组美容效果为满意者11例(91.7%)。两组患者的近期不良反应和美容效果评价差异均无统计学意义。结论应用HT与FF-IMRT技术进行保乳术后全乳放疗,可获得满意的近期临床效果,长期治疗效果还有待进一步随诊观察。
Objective To observe the early therapeutic effects,toxicities and cosmetic results of whole breast radiotherapy with helical tomotherapy(HT) or fixed-field intensity-modulated radiotherapy(FF-IMRT) in patients with early-stage breast cancer after breast-conserving surgery. Methods From September 2012 to March2013,24 patients with stage 0-ⅡB breast cancer after breast-conserving surgery were observed. HT and FF-IMRT were applied in 12 patients after breast-conserving surgery,respectively. The radiotherapy schedule was 46-50 Gy /23-25 fractions to the whole breast with a boost to the tumor bed to 60 Gy. Eleven patients(45. 8%) received chemotherapy and 18 patients(75%) received endocrine therapy. The targets and the organs-at-risk were evaluated. Toxic and cosmetic results were observed. Results Planning target volume(PTV) 105% and PTV 110% were significantly less for HT than FF-IMRT(P=0. 000,P=0. 023). Homogeneity index(P=0. 003) and conformity index(P=0. 002) were better for HT than FF-IMRT. HT achieved significant decrease in 5 Gy(P=0. 002),20 Gy(P=0. 001),and mean dose(P=0. 000) for ipsilateral lung. Similar results were obtained for both lungs and heart(all P<0. 05). In the HT group,10 patients developed grade 1 radiation dermatitis and 2 developed grade 2 radiation dermatitis; in the FF-IMRT group,11 developed grade 1 radiation dermatitis and 1 developed grade 2 radiation dermatitis. No radiation pneumonitis was observed in all patients.Twelve patients in HT group and 11 patients in FF-IMRT group developed satisfactory cosmetic results(P>0. 05). Conclusions Whole breast radiotherapy with HT or FF-IMRT for patients with early-stage breast cancer after breast-conserving surgery can achieve good therapeutic effectiveness,with satisfactory cosmetic results and acceptable toxicities,although the long-term clinical benefits need further observations.

关键词(KeyWords): 乳腺癌;放射治疗;保乳治疗;固定野调强放疗;螺旋断层调强放疗
breast cancer;radiotherapy;breastconserving surgery;fixed-field intensity-modulated radiation therapy;helical tomotherapy

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作者(Author): 侯晓荣;杨波;刘志凯;胡克;晏俊芳;沈晶;邱杰;张福泉;
HOU Xiao-rong;YANG Bo;LIU Zhi-kai;HU Ke;YAN Jun-fang;SHEN Jing;QIU Jie;ZHANG Fu-quan;Department of Radiation Oncology,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences &Peking Union Medical College;

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