保乳术综合三维适形放疗治疗Ⅰ期乳腺癌的临床观察(1)
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【摘要】 目的 观察Ⅰ期乳腺癌保乳术后三维适形放疗疗效及副作用。方法 30例确诊Ⅰ期乳腺癌患者保乳术后进行三维适形放疗。照射靶区为患侧全乳及胸壁和腋窝锁骨上区。全乳及胸壁采用半野切线对穿照射,90%PTV DT50 Gy/25次/5周,靶区内剂量分布±5.0%,患侧肺V20<20%。瘤床野以术痕外扩3.0 cm,避开乳头,银夹的位置为瘤床深度,5 mm等效膜填充,6MeV电子线追加照射,DT10 Gy/5次/1周。患侧腋窝锁骨上区6MV-X照射DT50 Gy/25次/5周。结果 随访5年未见局部复发。美容效果“优”和“好”100%。近期毒副反应可耐受。结论 早期乳腺癌保乳术加术后三维适形放疗局部控制率及美容效果满意,无严重并发症。
【关键词】 乳腺肿瘤;放射治疗;手术疗法;综合治疗;美容效果
Clinicaleffects ofbreast-conserving combining with three-dimensional conformal radiotherapy(3D CRT) for stageⅠbreast cancer
ZHANG Chun,ZHAO Yan-hai, ZHANG Xue-fang,et al.DepartmentofRadiationOncology,Dongguan People's Hospital,Dongguan523018,China
【Abstract】 Objective To observe thecurative effects and side reactions ofpatients suffer from stageⅠbreast cancer after breast-conserving combining with three-dimensional conformal radiotherapy(3D CRT).Methods Thirty clinical stageⅠbreast cancer patients received 3D CRT after breast-conserving therapy.A dose of 50 Gy with 6-MV X-rays was prescribed to the target volume consisting of the involved breast,chest wall,supraclavicular,and axillary nodes.And added 10 Gy to the tumor bed with 6-MeV electrons.Results The follow-up time was five years.No patients recurred.All patients obtained excellent cosmetic result.And the short term side reactions is acceptable.Conclusion Three-dimensional conformal radiotherapy combined with breast-conserving therapy can well achieve ideal local control rate and cosmetic outcome for earlier breast cancer.And no serious complication is observed.
【Key words】Breast cancer; Radiotherapy; Breast-conserving therapy; Combined modality; Cosmetic outcome
早期乳腺癌的治疗经历了从全乳腺切除加腋窝淋巴结清扫术,到乳腺肿瘤区段切除加腋窝、前哨淋巴结活检术。手术方式的转变影响到放射治疗的应用。近年来,国内外临床研究表明保乳术综合放疗治疗早期乳腺癌的局控率和生存率与传统治疗方法相似[1,2],但劳动能力和身心健康得到了保障。我院于2005年5月至2009年8月对30例确诊Ⅰ期乳腺癌患者保乳术后行三维适形放疗。现将疗效和毒副作用总结如下。
1 资料与方法
1.1 一般资料 30例确诊Ⅰ期乳腺癌患者,均为女性,年龄30~52岁。原发灶B超测定最大直径小于2 cm,左乳17例,右乳13例,原发灶位于乳腺上象限20例,乳腺下象限10例。术前检查均未发现腋窝淋巴结肿大。
1.2 手术方法 10例为区段切除联合同侧腋窝淋巴结清扫术,20例为肿块扩大切除联合同侧腋窝淋巴结清扫,原发灶位于上象限者采用乳晕外侧弧形切口,位于下象限者采用放射状切口,4~6枚银夹标记术野边界。术前均未行新辅助化疗。
1.3 术后病理 浸润性导管癌29例,髓样癌1例,切缘均未见肿瘤,同侧腋窝未见癌转移26例,4例见癌转移,但淋巴结转移个数少于4个。腋窝淋巴结检查个数7~20枚。
1.4 化疗情况 术前均未化疗,术后化疗2~6周期 ......
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