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目的:探究行保守手术治疗的同期双侧乳腺癌患者，采用容积旋转调强放疗对患者急性期和晚期皮肤毒性和放射诱发的肺纤维化的影响。方法:选择2017年1月至2018年12月浙江省肿瘤医院236例同期双侧乳腺癌患者为研究对象，所有患者均接受容积调制弧光（VMAT/RapidArcn ?）治疗，于治疗期间及治疗后进行临床检查以检测放疗相关的皮肤毒性，同时在随访阶段通过高分辨率计算机断层扫描对肺纤维化程度进行评价。n 结果:220例患者进行了深吸气屏气技术（DIBH）扫描，剩余16例因依从性差（无法耐受屏住呼吸至少20 s）行自由呼吸（FB）扫描，采用DIBH扫描的患者右肺体积为（2 416.3 ± 550.8）cc，FB扫描患者右肺体积为（1 278.6 ± 514.3）cc；采用DIBH扫描的患者左肺体积为（2 125.4 ± 428.6）cc，FB扫描患者左肺体积为（1 058.9 ± 520.5）cc，DIBH和FB的肺容量比较差异有统计学意义（n P右肺 = 0.001，n P左肺 = 0.001）。169例（71.6%）出现1级皮肤毒性，56例（23.7%）为2级，2例（0.8%）为3级，9例（3.8%）无任何皮肤毒性反应。在放疗期间、放疗结束6个月均无症状性放射性肺炎、肺纤维化。晚期皮肤毒性评价显示绝大多数患者无明显皮肤毒性反应，皮肤毒性反应中主要以毛细血管扩张症、乳房水肿和皮肤萎缩为主；12例出现肺纤维化表现，检测到肺纤维化的随访时间为12 ~ 28（12.5 ± 0.6）个月。肺部纤维化病变的体积为1.5 ~ 18.3（6.6 ± 1.0）cc。部分体积（V20、V30、V40及V50）与肺纤维化发生风险显著相关（n P < 0.01）；在12 ~ 33（28.6 ± 1.2）个月的随访时间内无复发生存期和总生存期均为100.0%。n 结论:容积旋转调强放疗治疗保守手术后同期双侧乳腺癌患者是较为安全和有效的，值得临床上参考和应用。“,”Objective:To investigate the effects of volume-modulated intensity-modulated radiotherapy on acute and advanced skin toxicity and radiation-induced pulmonary fibrosis in patients with bilateral breast cancer after conservative surgery.Methods:The study period was from January 2017 to December 2018. A total of 236 patients with bilateral breast cancer who received treatment in Zhejiang Cancer Hospital were included in the study.All patients received volume-modulated arc light (VMAT/RapidArcn ?) treatment. The treatment was performed during and after treatment. Clinical examination was performed to detect radiation-related skin toxicity, and pulmonary fibrosis was evaluated and analyzed by high-resolution computed tomography (HRCT) during follow-up.n Results:A total of 220 patients underwent deep inhalation breath holding (DIBH) scans. The remaining 16 patients underwent free breathing (FB) scans due to poor adherence (patients could not tolerate holding for at least 20 s). There was a significant difference in lung capacity between DIBH and FB [right lung: (2 416.3 ± 550.8) cc vs. (1 278.6 ± 514.3) cc, n P = 0.001; left Lung: (2 125.4 ± 428.6) cc vs. (1 058.9 ± 520.5) cc vs. n P <0.001]. One hundred and sixty-nine patients (71.6%) had grade 1 skin toxicity, 56 patients (23.7%) were grade 2, 2 patients (0.8%) were grade 3, and 9 patients did not have any skin toxicity. There were no symptomatic radiation pneumonitis and pulmonary fibrosis cases during radiotherapy and 6 months after radiotherapy. Advanced skin toxicity evaluation showed that most patients had no obvious skin toxicity. The major skin toxicity reactions were capillary telangiectasia, breast edema, and skin atrophy. Pulmonary fibrosis appeared in 12 patients, and mean follow-up was detected. The time was 12-28 (12.5 ± 0.6) months. The average volume of pulmonary fibrotic lesions was 1.5-18.3 (6.6 ± 1.0) cc. Partial volumes (V n 20, Vn 30, Vn 40, and Vn 50) were significantly associated with the risk of pulmonary fibrosis (n P < 0.01). Recurrence-free survival (RFS) during an average follow-up time was 12-33 (28.6 ± 1.2) months, and overall survival (OS) were both 100.0%.n Conclusions:Based on the evaluation of acute and advanced skin toxicity and radiation-induced pulmonary fibrosis, volume-rotation IMRT is safe and effective for patients with bilateral breast cancer after conservative surgery, and it is worthy of clinical reference and application.