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目的评价乳腺癌患者保乳手术后放射治疗乳腺靶区的剂量分布及疗效。方法乳腺癌单发病灶确诊患者25例,行保乳肿瘤根治+前哨淋巴结活检术,肿瘤>5cm的Ⅲ期患者先行新辅助化疗后再行手术。所有患者CT扫描后图像数据导入治疗计划系统,乳腺靶区包括乳腺腺体组织、瘤床银夹外放1.5cm,后达胸壁,前达皮肤的整个乳腺区域,Ⅲ期还包括胸壁皮肤与锁骨上区。6MeVX线全乳腺照射DT5000cGy,9MeVE线瘤床局部加量DT1000￣1500cGy;锁骨上野照射DT5000cGy。结果25例患者放射治疗计划系统靶区设计显示靶区内剂量分布为95.4%￣104.4%,治疗后随访时间3￣20月,均未见肿瘤局部复发或远处转移;Ⅲ期的患者由于使用填充物,皮肤反应较重,9例出现Ⅲ度皮肤反应,2例出现Ⅳ度皮肤反应,均于治疗后恢复。结论乳腺癌的保乳手术+术后放疗与乳腺癌根治术有相同的疗效,且保持了形体的完整,提高了生活质量。放疗是保乳术后不可缺少的辅助治疗,为预防局部复发的主要手段。采用三维适形放疗可以获得较二维放疗更优的乳腺靶体积内的剂量分布,同时降低肺和心脏等正常组织的辐射受量,有望得到更满意的疗效和美容效果。
Objective To evaluate the dose distribution and therapeutic effect of breast cancer target after breast conserving surgery. Methods Twenty-five patients diagnosed as single breast lesions were treated with conservative radical prostatectomy plus sentinel lymph node biopsy. Patients with stage Ⅲ> 5 cm were treated with neoadjuvant chemotherapy before surgery. All patients CT scan image data into the treatment planning system, the breast target area, including breast gland tissue, tumor bed silver clip placed 1.5cm, after the chest wall, the skin up to the entire breast area, stage Ⅲ also includes chest wall and clavicle Upper district. 6MeVX line full breast irradiation DT5000cGy, 9MeVE line tumor bed local dose DT1000 ~ 1500cGy; supraclavicular irradiation DT5000cGy. Results The target design of the radiotherapy planning system in 25 patients showed that the dose distribution in the target area was 95.4% ~ 104.4% and the follow-up time was 3 ~ 20 months after treatment. No local recurrence or distant metastasis was found in the patients. In the stage Ⅲ patients, Fillers, the skin reaction was severe, 9 cases appeared Ⅲ degree skin reaction, 2 cases of grade Ⅳ skin reaction, were recovered after treatment. Conclusion Breast conserving surgery + postoperative radiotherapy has the same effect as radical mastectomy, and maintains the integrity of the body and improves the quality of life. Radiotherapy is an indispensable adjunctive therapy after breast-conserving surgery, as the main means to prevent local recurrence. The use of three-dimensional conformal radiotherapy can obtain better dose distribution in breast target volume than two-dimensional radiotherapy and reduce the amount of radiation exposure of normal tissues such as lung and heart, which is expected to achieve more satisfactory curative effect and cosmetic effect.