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侯晓荣, 杨波, 刘志凯, 胡克, 晏俊芳, 沈晶, 邱杰, 张福泉. 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[J]. 协和医学杂志, 2013, 4(4): 377-382. DOI: 10.3969/j.issn.1674-9081.2013.04.007
引用本文: 侯晓荣, 杨波, 刘志凯, 胡克, 晏俊芳, 沈晶, 邱杰, 张福泉. 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[J]. 协和医学杂志, 2013, 4(4): 377-382. DOI: 10.3969/j.issn.1674-9081.2013.04.007
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Xiao-rong HOU, Bo YANG, Zhi-kai LIU, Ke HU, Jun-fang YAN, Jing SHEN, Jie QIU, Fu-quan ZHANG. Early Clinical Results of Whole Breast Irradiation with Helical Tomotherapy or Fixed-field Intensity-modulated Radiation Therapy[J]. Medical Journal of Peking Union Medical College Hospital, 2013, 4(4): 377-382. DOI: 10.3969/j.issn.1674-9081.2013.04.007
Citation: Xiao-rong HOU, Bo YANG, Zhi-kai LIU, Ke HU, Jun-fang YAN, Jing SHEN, Jie QIU, Fu-quan ZHANG. Early Clinical Results of Whole Breast Irradiation with Helical Tomotherapy or Fixed-field Intensity-modulated Radiation Therapy[J]. Medical Journal of Peking Union Medical College Hospital, 2013, 4(4): 377-382. DOI: 10.3969/j.issn.1674-9081.2013.04.007
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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

    摘要
  • 摘要:
      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。

     

    Abstract:
      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 March 2013, 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.

     

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