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目的研究乳腺癌术后大分割放疗的疗效、疗程和副反应。方法60例乳腺癌术后需放疗病例随机均分为大分割放疗组(HOFRT组)和常规放疗组(CRT组)。两组病例根据TNM分期、腋窝淋巴结转移数等设内乳野、锁腋野、胸壁野。HOFRT组的胸壁野照射采用切线对穿照射,HOFRT组第1、3天为5.0 Gy/次,第15、17天为6.5 Gy/次,共23 Gy分4次17 d完成。CRT组2.0～2.5 Gy/次,共45-50 Gy分20～25次4-5周完成。HOFRT组10例和CRT组9例腋窝后野加量10-15 Gy分5～7次5～7 d完成。HOFRT、CRT组总疗程分别为3.1～3.4、4.7-6.0周。结果HOFRT、CRT组10年总生存率分别接近56%、39%,Ⅲ期10年生存率分别接近41%、52%(P>0.05),局部复发率分别接近13%、10%(P>0.05)。HOFRT和CRT组放疗晚期损伤导致的患肢淋巴水肿、活动受限发生率分别接近23%、3%和11%、7%(P>0.05)。HOFRT组急性2+3级放射性皮肤损伤显著低于CRT组(10%:43%,P<0.01)。结论大分割放疗是一种短疗程、安全、有效的乳腺癌术后放疗方案,局部复发、生存率和晚期副反应与常规放疗无差异,值得进一步研究。
Objective To study the curative effect, course of treatment and side effects of major fractionated radiotherapy for postoperative breast cancer. Methods Sixty cases of breast cancer patients undergoing postoperative radiotherapy were randomly divided into two groups: the large fractionated radiotherapy group (HOFRT group) and the conventional radiotherapy group (CRT group). Two groups of patients according to TNM staging, axillary lymph node metastasis number within the milk field, lock axillary field, chest wall field. In the HOFRT group, the chest wall irradiation was performed by tangential irradiation. The HOFRT group was 5.0 Gy on the 1st and 3rd days, 6.5 Gy on the 15th and 17th days, and 23 Gy on 4 and 17 days. CRT group 2.0 ~ 2.5 Gy / times, a total of 45-50 Gy points 20 to 25 times 4-5 weeks to complete. 10 cases of HOFRT group and 9 cases of CRT group were treated with 10-15 Gy after axillary posterior for 5-7 times for 5-7 days. HOFRT, CRT total course of treatment were 3.1 ~ 3.4, 4.7-6.0 weeks. Results The 10-year overall survival rates of HOFRT and CRT group were close to 56% and 39%, respectively. The 10-year survival rates of stage Ⅲ were 41% and 52% respectively (P> 0.05). The local recurrence rates were close to 13% and 10% 0.05). The incidence of limb lymphedema and active limitation in HOFRT and CRT group were nearly 23%, 3% and 11%, 7%, respectively (P> 0.05). The acute grade 2 + 3 radioactive skin lesions in HOFRT group were significantly lower than those in CRT group (10% vs 43%, P <0.01). Conclusion Large-fractionated radiotherapy is a short-course, safe and effective regimen of postoperative radiotherapy for breast cancer. Local recurrence, survival rate, and late-stage adverse reactions are not different from conventional radiotherapy and should be further studied.