早期乳腺癌根治术后辅助放射治疗的研究
http://www.100md.com
参见附件(100kb)。
中国医学科学院肿瘤医院 余子豪 王淑莲 吴君心 惠周光
【摘要】目的 探讨早期乳腺癌根治术后辅助性放疗的适应证、剂量分割方案及照射技术。 方法： 对本院早期乳腺癌根治术后接受辅助性放疗的患者做回顾性分析，与同期病例进行比较、分析。 结果 1. 我院 1983 ～ 1991 年间收治早期乳腺癌根治性手术后患者 605 例。对腋窝淋巴结转移 1~3 个患者，单纯术后全身治疗的 10 年局部区域复发率、总生存率和无瘤生存率分别为 0 %、 91.7 %和 88.9 %，加做术后放射治疗者分别为 4.7 %、 90.4 %和 77.2 %，两者无显著性差异( P >0.05 )。腋窝淋巴结转移 3 4 个的患者单纯术后全身治疗组局部区域复发率高达 40.1 %，加作术后放射治疗时降为 15.1 %，差异有极显著性 ( P =0.001) ，术后放射治疗还使总生存率 54.4 %提高为 67.1 %；无瘤生存率 30.5 %提高为 57.3 %，差异均有显著性( P =0.04 和 P =0.001 )。 2. 1987 年 1 月到 1993 年 1 月在我院进行术后放疗的早期乳腺癌病例 367 例，术后放射治疗应用了三种剂量分割方案，即：( 1 )常规分割：每次 200 cGy ，每日 1 次，每周 5 次，总剂量 5000cGy/25 次 /5 周。( 2 )隔日照射：每次 300cGy ，隔日照射，每周 3 次，总剂量 4500cGy/15 次 /5 周。( 3 )快速照射：第 1 天和第 3 天各照射 1 次，每次 500cGy ，第 15 天和第 17 天各照射 1 次，每次 650cGy ，总剂量 2300cGy/4f/17d 。中位随访 62.7 个月，各组的局部区域复发率分别为 2.7% 、 2.8% 和 2.4% 。放射性肺纤维化发生率无统计学差异。通过 LQ 模型的换算，支持乳腺癌增殖慢、 α/β 值低于 4Gy 的观点。( 3 )三维剂量学比较显示两野切线照射技术对靶区的包含度及剂量分布的均匀性比电子束垂直照射的好；但电子束照射对心肺的保护比两野切线照射技术好。
【 Abstract 】 Objective To investigate the indication, fractionation schedule and radiotherapeutic technique of postmastectomy radiotherapy for early breast cancer. Methods Retrospective analysis of results of postmastectomy radiotherapy for early stage breast cancer patients treated in our department, comparing with the results of patients without postmastectomy radiotherapy. Results 1. From 1983 to 1991, 605 patients with T 1-2 N 0-1 M 0 breast cancer were treated by radical mastectomy in our Hospital. 149 patients underwent surgery alone(S group), and the remaining 456 patients received postoperative adjuvant treatment. Of these patients, 135 received postoperative radiotherapy(S+R group), 113 adjuvant chemotherapy or tamoxifen(S+Y group), and 208 adjuvant chemotherapy or tamoxifen plus radiotherapy(S+Y+R group). Only for patients with four or more positive nodes who had had systematic therapy, radiotherapy was beneficial; the 10-year actuarial LRR of patients who received systematic therapy only was 40.1% as compared with 15.1% of those who received systematic therapy plus radiotherapy; Their OS rates were 55.4% and 67.1% ( P =0.040) and their DFS rates were 30.5% and 57.3% ( P =0.001). 2. Between 1987 and 1993, 367 patients with T 1-2 breast cancer, who received different fractionation schedules of postoperative radiotherapy, were analyzed retrospectively. Group A (Conventional group) consisted of conventional radiotherapy with 200 cGy per fraction, 5 fractions per week, total dose 5000 cGy/ 25f/5weeks, Group B with 300 cGy per fraction, 3 fractions per week, total dose 4500cGy/15f/5week, and Group C ( Hypofractionation group) with 500 cGy on day1, 3 and 650 cGy on day 15 and 17, total dose 2300 cGy/4f/17days. With a median follow-up of 62.7 months, the local regional relapse rates were 2.7% for Group A, 2.8% for Group B, and 2.4% for Group C, respectively. No difference in incidence of lung fibrosis after radiotherapy were observed among these three groups. According to the caculation by Linear-Quadratic model, it is suggested that breast cancer had a low α/β value. Conclusions Post-mastectomy r adiotherapy is able to significantly decrease the locoregional recurrence and improve the survival of patients with four or more positive axillary nodes. We suggest that postmastectomy radiotherapy be taken as routine for these patients. Preliminary data showed that the results of hypofractionation schedule in postoperative radiotherapy of breast cancer was the same as that of conventional fractionation radiotherapy, but it should be confirmed in further clinical study. ......
中国医学科学院肿瘤医院 余子豪 王淑莲 吴君心 惠周光
【摘要】目的 探讨早期乳腺癌根治术后辅助性放疗的适应证、剂量分割方案及照射技术。 方法： 对本院早期乳腺癌根治术后接受辅助性放疗的患者做回顾性分析，与同期病例进行比较、分析。 结果 1. 我院 1983 ～ 1991 年间收治早期乳腺癌根治性手术后患者 605 例。对腋窝淋巴结转移 1~3 个患者，单纯术后全身治疗的 10 年局部区域复发率、总生存率和无瘤生存率分别为 0 %、 91.7 %和 88.9 %，加做术后放射治疗者分别为 4.7 %、 90.4 %和 77.2 %，两者无显著性差异( P >0.05 )。腋窝淋巴结转移 3 4 个的患者单纯术后全身治疗组局部区域复发率高达 40.1 %，加作术后放射治疗时降为 15.1 %，差异有极显著性 ( P =0.001) ，术后放射治疗还使总生存率 54.4 %提高为 67.1 %；无瘤生存率 30.5 %提高为 57.3 %，差异均有显著性( P =0.04 和 P =0.001 )。 2. 1987 年 1 月到 1993 年 1 月在我院进行术后放疗的早期乳腺癌病例 367 例，术后放射治疗应用了三种剂量分割方案，即：( 1 )常规分割：每次 200 cGy ，每日 1 次，每周 5 次，总剂量 5000cGy/25 次 /5 周。( 2 )隔日照射：每次 300cGy ，隔日照射，每周 3 次，总剂量 4500cGy/15 次 /5 周。( 3 )快速照射：第 1 天和第 3 天各照射 1 次，每次 500cGy ，第 15 天和第 17 天各照射 1 次，每次 650cGy ，总剂量 2300cGy/4f/17d 。中位随访 62.7 个月，各组的局部区域复发率分别为 2.7% 、 2.8% 和 2.4% 。放射性肺纤维化发生率无统计学差异。通过 LQ 模型的换算，支持乳腺癌增殖慢、 α/β 值低于 4Gy 的观点。( 3 )三维剂量学比较显示两野切线照射技术对靶区的包含度及剂量分布的均匀性比电子束垂直照射的好；但电子束照射对心肺的保护比两野切线照射技术好。
【 Abstract 】 Objective To investigate the indication, fractionation schedule and radiotherapeutic technique of postmastectomy radiotherapy for early breast cancer. Methods Retrospective analysis of results of postmastectomy radiotherapy for early stage breast cancer patients treated in our department, comparing with the results of patients without postmastectomy radiotherapy. Results 1. From 1983 to 1991, 605 patients with T 1-2 N 0-1 M 0 breast cancer were treated by radical mastectomy in our Hospital. 149 patients underwent surgery alone(S group), and the remaining 456 patients received postoperative adjuvant treatment. Of these patients, 135 received postoperative radiotherapy(S+R group), 113 adjuvant chemotherapy or tamoxifen(S+Y group), and 208 adjuvant chemotherapy or tamoxifen plus radiotherapy(S+Y+R group). Only for patients with four or more positive nodes who had had systematic therapy, radiotherapy was beneficial; the 10-year actuarial LRR of patients who received systematic therapy only was 40.1% as compared with 15.1% of those who received systematic therapy plus radiotherapy; Their OS rates were 55.4% and 67.1% ( P =0.040) and their DFS rates were 30.5% and 57.3% ( P =0.001). 2. Between 1987 and 1993, 367 patients with T 1-2 breast cancer, who received different fractionation schedules of postoperative radiotherapy, were analyzed retrospectively. Group A (Conventional group) consisted of conventional radiotherapy with 200 cGy per fraction, 5 fractions per week, total dose 5000 cGy/ 25f/5weeks, Group B with 300 cGy per fraction, 3 fractions per week, total dose 4500cGy/15f/5week, and Group C ( Hypofractionation group) with 500 cGy on day1, 3 and 650 cGy on day 15 and 17, total dose 2300 cGy/4f/17days. With a median follow-up of 62.7 months, the local regional relapse rates were 2.7% for Group A, 2.8% for Group B, and 2.4% for Group C, respectively. No difference in incidence of lung fibrosis after radiotherapy were observed among these three groups. According to the caculation by Linear-Quadratic model, it is suggested that breast cancer had a low α/β value. Conclusions Post-mastectomy r adiotherapy is able to significantly decrease the locoregional recurrence and improve the survival of patients with four or more positive axillary nodes. We suggest that postmastectomy radiotherapy be taken as routine for these patients. Preliminary data showed that the results of hypofractionation schedule in postoperative radiotherapy of breast cancer was the same as that of conventional fractionation radiotherapy, but it should be confirmed in further clinical study. ......
您现在查看是摘要介绍页，详见DOC附件(100kb)。