·324·，保乳术后乳腺癌三维适形或调强放疗早期毒副反应分析

姚

波，王雅棣，许卫东，高军茂

Earlytoxicityintheskinandlungforbreast－conservingcancerpatientswiththree－

dimensionalconformalorintensity－modulatedradiotherapy

YaoBo，WangYadi，XuWeidong，GaoJunmao

DepartmentofRadiationOncology，GeneralHospitalofBeijingMilitaryCommand，Beijing100700，China．

【Abstract】Objective:Toanalyzetheearlyskinandlungtoxicityafterthree－dimensionalconformalradiotherapy(3DCRT)orintensity－modulatedradiotherapy(IMRT)inbreastcancerpatientswithconservingsurgery．Meth-ods:Eighty－oneconservativebreastcancerpatientswerestudiedretrospectively．Thirty－twopatientsweretreatedwith3DCRTand49withIMRT．Thewhole－breastwasirradiatedalonein56patientsand25patientsreceivedthewhole－breastandsupraclavicularfossairradiationtogether．Nopatientswereirradiatedintheaxillaryorinternalmammarylymphnoderegion．Thedoseofclinicaltargetvolume(CTV)was50Gyin25fractionsover5weeks，fol-lowedbyanelectronboostof15Gyin5fractionstothetumorbed．Fifteenpatientsunderwentradiotherapy(RT)a-loneandtheotherscombinedwithchemotherapy(CT)．Results:GradeⅠacutedermatitisoccurredin35patients

(43．2%)，gradeⅡin44patients(54．3%)andgradeⅢin2patients(2．5%)．Thefrequencyofgrade≥Ⅱder-matitiswasmoreinthepatientswith3DCRTthanwithIMRT，78．1%and42．9%respectively，P=0．002．Offifty－sixpatientswithoutsupraclavicularirradiation，24patientsexperiencedgradeⅠdermatitisand32hadgrade≥Ⅱ．

respectively，P=0．005．Thefre-ThemeanvolumeoftheCTVsinthetwogroupswere543．21cm3and688．81cm3，

quencyofdermatitiswasnotassociatedwiththesequenceofRTandCT．GradeⅠacuteradiationpneumonitis(RP)

withclinicallysignificantsymptomoccurredin7patients(8．6%)，grade≥Ⅱinone，respectively．GradeⅠRPoc-curredin5patientsandgrade≥Ⅱin2patientswithIMRT．GradeⅠRPoccurredin2patientsandnonehadgrade≥ⅡRPin3DCRT．Nodifferenceswereobservedintwogroups．Theotherfactorsincludingthedose－volumedeliv-age，CToredocrinetherapydidnotaffectRP．Conclusion:Thebreastcancerpatientswithconservativeeredtolung，

surgeryreceivedeitherIMRTor3DCRTexperiencedmildormoderateacutedermatitis．IMRThadbetterprotectiveef-fectiononbreastskincomparedwith3DCRT．Thebreastvolumewasassociatedwithacutedermatitis．ThefrequenciesofclinicallysignificantRPwereseldominthestudy．NorelationshipswerefoundbetweenclinicalordosimetricfactorsandRP．

【Keywords】breastcancer;conservativesurgery;three－dimensionalconformalradiotherapy(3DCRT);intensity－modulatedradiotherapy(IMRT);dermatitis;pneumonitis

ModernOncology2013，21(02):0324－0327

【摘要】目的：分析乳腺癌保乳术后三维适形放疗（3DCRT）或调强放射治疗（IMRT）早期放射性皮炎和肺炎

3DCRT治疗32例，IMRT治疗的发生率及相关的临床与剂量学因素。方法：回顾分析81例保乳术后乳腺癌，

49例。单纯全乳腺放疗56例，乳腺联合锁上照射25例，均未照射腋窝或内乳。乳腺联合锁上剂量

50Gy/25次，瘤床补量15Gy/5次。单纯放疗16例，其余均为放化综合治疗。结果：Ⅰ度皮肤反应35例（43．2%），Ⅱ度44例（54．3%），Ⅲ度仅2例（2．5%）。3DCRT组25例（78．1%）发生Ⅱ－Ⅲ度急性皮肤反

P=0．002。56例锁上未放疗者，24例Ⅰ度反应和32例Ⅱ－Ⅲ度反应的临应，高于IMRT组21例（42．9%），

33

P=0．005。放化疗顺序对皮肤反应没有影响。有床靶区（CTV）体积均数分别为543．21cm和688．81cm，

临床症状的I度放射性肺炎7例（8．6%），Ⅱ度和Ⅲ度各1例。IMRT组Ⅰ度5例，Ⅱ－Ⅲ度2例；3DCRT组I度2例，无Ⅱ度及以上放射性肺炎发生。两组比较差异未见统计学意义。剂量体积因素及临床因素如年龄、

化疗、内分泌治疗等对放射性肺炎无影响。结论：无论IMRT还是3DCRT，严重的急性皮肤反应均较低，但是IMRT较3DCRT能更好的保护乳腺皮肤；乳腺体积大者皮肤反应发生率高。本研究中有症状的肺炎发

【收稿日期】2012－01－16【修回日期】2012－02－03

【作者单位】北京军区总医院放疗科，北京100700

【作者简介】姚波（1971－），女，山西临汾人，硕士，主治医师，主要从事腹部肿瘤放射治疗工作。E－mail：yaobo898@sina．com．cn