乳腺癌患者保乳术后五种放疗技术的疗效比较研究

doi:10.11904/j.issn.1002-3070.2023.03.005

实用肿瘤学杂志 ›› 2023, Vol. 37 ›› Issue (3): 224-229.doi: 10.11904/j.issn.1002-3070.2023.03.005

乳腺癌患者保乳术后五种放疗技术的疗效比较研究

张庆怀¹, 韩阿蒙², 杨森¹, 李秀梅¹, 赵健鑫¹, 张彦秋¹

1.秦皇岛市第一医院肿瘤放疗科(秦皇岛 066000);
2.燕山大学信息中心

收稿日期:2022-10-11 修回日期:2023-06-07 出版日期:2023-06-28 发布日期:2023-08-07
通讯作者: 张彦秋,E-mail:zmary198589@163.com
作者简介:张庆怀,男,(1973-),硕士,副主任技师,从事肿瘤放疗物理学的研究。
基金资助:
2018年度河北省医学科学研究重点课题计划(编号:20181196)

A comparative study of five radiotherapy techniques for breast cancer patients after breast-conserving surgery

ZHANG Qinghuai¹, HAN Ameng², YANG Sen¹, LI Xiumei¹, ZHAO Jianxin¹, ZHANG Yanqiu¹

1. Department of Radiation Therapy,The First Hospital of Qinhuangdao,Qinhuangdao 066000,China;
2. Information Technology Center,Yanshan University

Received:2022-10-11 Revised:2023-06-07 Online:2023-06-28 Published:2023-08-07

摘要/Abstract

摘要： 目的研究乳腺癌患者保乳术后行五种放疗技术后生存期和副作用的差异。方法选取2015年1月1日—2017年1月1日在秦皇岛市第一医院肿瘤放疗科治疗的乳腺癌保乳术患者200例,随机分为五组,每组40例患者。第一组(3D-CRT组)选择3D-CRT技术,第二组(ff-IMRT组)选择ff-IMRT技术,第三组(VMAT组)选择VMAT技术,第四组(CRT+IMRT组)选择CRT+IMRT技术,第五组(CRT+VMAT组)选择CRT+VMAT技术。从患者保乳手术后,全组患者随访5年以上。随访后评价患者的疗效和副作用,疗效评价包括局部区域复发(LR)、远处转移(DM)、无病生存期(DFS)、总生存期(OS);副作用评价包括急性放射性肺炎、急性放射性皮炎和晚期放射性心脏损伤。结果五组患者间DM率存在统计学差异(P=0.005),CRT+VMAT组的DM率低于其他四组。CRT+VMAT组患者的中位生存期(DFS、OS)明显高于其他四组(P＜0.001)。CRT+IMRT组的0级急性放射性肺炎发生率低于VMAT组(P=0.048);CRT+VMAT组的2级急性放射性肺炎发生率低于ff-IMRT组(P=0.015);CRT+VMAT组的2级急性放射性皮炎发生率低于VMAT组(P=0.032);CRT+VMAT组的2级晚期放射性心脏损伤发生率低于VMAT组的1级晚期放射性心脏损伤发生率(P=0.047)。结论 CRT+VMAT技术的疗效优于3D-CRT,ff-IMRT,VMAT,CRT+IMRT四种放疗技术,放疗副反应低于CRT,ff-IMRT,VMAT,CRT+IMRT四种技术。CRT+VMAT技术值得在临床实践中推广,乳腺癌保乳术后放疗优先推荐CRT+VMAT技术。

关键词: 乳腺癌保乳术, 放疗技术, 放射治疗, 疗效

Abstract: Objective The aim of this study was to study the differences of survival time and side effects of five radiotherapy techniques for breast cancer patients after breast conserving surgery. Methods Two hundred patients with breast cancer who received breast conserving surgery in the department of Tumor Radiotherapy,the First Hospital of Qinhuangdao from January 1,2015 to January 1,2017 were selected and randomly divided into five groups with 40 patients in each group.The first group (3D-CRT group)selected 3D-CRT technology,the second group (ff-IMRT group)selected ff-IMRT technology,the third group (VMAT group)selected VMAT technology,the fourth group (CRT+IMRT Group)selected CRT+IMRT technology,and the fifth group (CRT+VMAT group)selected CRT+VMAT technology.After breast-conserving surgery,all patients in the group were followed up for more than 5 years.The curative effect and side effects of the patients were evaluated after follow-up,including local recurrence (LR),distant metastasis (DM),disease-free survival (DFS),and overall survival (OS).The evaluation of side effects included acute radiation pneumonia,acute radiation dermatitis,and late stage radiation induced cardiac injury. Results There was a statistical difference for the DM rate among the five groups of patients (P=0.005),and the DM rate in the CRT+VMAT group was lower than that in the other four groups.The median time (DFS,OS)of patients in the CRT+VMAT group was significantly higher than those of the other four groups (P＜0.001).The incidence of grade 0 acute radiation pneumonia in the CRT+IMRT group was lower than that in the VMAT group (P=0.048).The incidence of grade 2 acute radiation pneumonia in the CRT+VMAT group was lower than that in the ff-IMRT group (P=0.015).The incidence of grade 2 acute radiation dermatitis in the CRT+VMAT group was lower than that in the VMAT group (P=0.032).The incidence of grade 2 late radiation cardiac injury in the CRT+VMAT group was lower than that in the VMAT group (P=0.047). Conclusion The efficacy of CRT+VMAT technology is better than that of 3D-CRT,ff-IMRT,VMAT,CRT+IMRT,and the side effects of radiotherapy are lower than those of CRT,ff-IMRT,VMAT and CRT+IMRT.The CRT+VMAT techniques is worth popularizing in clinical practice.The CRT+VMAT technology is preferred for radiotherapy after breast conserving surgery for breast cancer patients.

Key words: Breast-conserving surgery for breast cancer, Radiotherapy technology, Curative effect

中图分类号:

R730.55

张庆怀, 韩阿蒙, 杨森, 李秀梅, 赵健鑫, 张彦秋. 乳腺癌患者保乳术后五种放疗技术的疗效比较研究[J]. 实用肿瘤学杂志, 2023, 37(3): 224-229.

ZHANG Qinghuai, HAN Ameng, YANG Sen, LI Xiumei, ZHAO Jianxin, ZHANG Yanqiu. A comparative study of five radiotherapy techniques for breast cancer patients after breast-conserving surgery[J]. Journal of Practical Oncology, 2023, 37(3): 224-229.

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乳腺癌患者保乳术后五种放疗技术的疗效比较研究

A comparative study of five radiotherapy techniques for breast cancer patients after breast-conserving surgery

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