切换至 "中华医学电子期刊资源库"

中华乳腺病杂志(电子版) ›› 2015, Vol. 09 ›› Issue (03) : 173 -177. doi: 10.3877/cma.j.issn.1674-0807.2015.03.004

论著

早期乳腺癌保留乳房手术联合术中放射治疗的近期疗效
俞伟1, 马林1,(), 鞠忠建1, 李席如2, 王建东2, 张艳君2, 孔庆龙3, 巩汉顺1   
  1. 1.100853 北京,解放军总医院放射治疗科
    2.100853 北京,解放军总医院普外科
    3.100853 北京,解放军总医院肿瘤外科
  • 收稿日期:2015-05-16 出版日期:2015-06-01
  • 通信作者: 马林

Short-term efficacy of breast-conserving surgery plus intraoperative radiotherapy for early stage breast cancer

Wei Yu1, Lin Ma1,(), Zhongjian Ju1, Xiru Li2, Jiandong Wang2, Yanjun Zhang2, Qinglong Kong3, Hanshun Gong1   

  1. 1.Department of Radiation Oncology
    2.Department of General Surgery
    3.Department of Oncological Surgery, General Hospital of Chinese PLA, Beijing 100853, China
  • Received:2015-05-16 Published:2015-06-01
  • Corresponding author: Lin Ma
引用本文:

俞伟, 马林, 鞠忠建, 李席如, 王建东, 张艳君, 孔庆龙, 巩汉顺. 早期乳腺癌保留乳房手术联合术中放射治疗的近期疗效[J/OL]. 中华乳腺病杂志(电子版), 2015, 09(03): 173-177.

Wei Yu, Lin Ma, Zhongjian Ju, Xiru Li, Jiandong Wang, Yanjun Zhang, Qinglong Kong, Hanshun Gong. Short-term efficacy of breast-conserving surgery plus intraoperative radiotherapy for early stage breast cancer[J/OL]. Chinese Journal of Breast Disease(Electronic Edition), 2015, 09(03): 173-177.

目的

分析早期乳腺癌保留乳房(简称保乳)手术联合术中放射治疗的近期疗效、不良反应及美容效果。

方法

回顾性分析解放军总医院2008 年12 月至2012 年3 月收治的75 例早期乳腺癌患者行保乳手术联合术中放射治疗的临床资料。 所有患者于肿瘤切除前行电子线术中放射治疗,剂量为8 Gy 或15 Gy。 观察术后近期治疗效果、不良反应及美容效果。 采用Kaplan-Meier 法计算局部复发率和生存率。

结果

中位随访54 个月(30 ~66 个月),2 例(2.7%,2/75)患者出现术后血肿,6 例(8.0%,6/75)患者出现轻微的乳腺纤维化,1 例(1.3%,1/75)患者出现术后感染,16 例(21.3%,16/75)患者出现1 级放射性肺损伤。 术后美容效果优、良率分别为57.3%(43/75)和30.7%(23/75)。 患者术后3 年的局部复发率为5.3%(4/75),3 年的无瘤生存率为94.7%(71/75)。

结论

早期乳腺癌保乳手术联合术中放射治疗的近期疗效和美容效果均良好,且不良反应轻微。

Objective

To evaluate the short-term efficacy, adverse reaction and cosmetic effect of breast-conserving surgery plus intraoperative electron radiotherapy (IOERT) for early stage breast cancer.

Methods

We retrospectively analyzed the clinical data of 75 breast cancer patients who underwent breastconserving surgery combined with IOERT in General Hospital of Chinese PLA from December 2008 to March 2013.All patients were treated with IOERT at the dosage of 8 or 15 Gy before tumor resection.The short-term efficacy, adverse reaction and cosmetic effect were evaluated after operation.Kaplan-Meier method was used to calculate the local recurrence and overall survival.

Results

Median follow-up period was 54 months (30-60)months.Two (2.7%, 2/75) patients developed postoperative hematoma.Six (8.0%, 6/75) patients developed mild breast fibrosis.One (1.3%, 1/75) patient experienced postoperative infection.Sixteen(21.3%,16/75) patients developed grade 1 radiation-induced pulmonary injury.Forty-three (57.3%,43/75)patients had excellent cosmetic outcome and 23 (30.7%,23/75) had good cosmetic outcome.The 3-year local recurrence rate was 5.3% (4/75) and the 3-year disease-free survival rate was 94.7% (71/75).

Conclusion

The breast-conserving surgery combined with IOERT shows good short-term efficacy and cosmetic outcome in early stage breast cancer patients, with mild adverse reaction.

表1 75 例乳腺癌患者的临床特征
表2 75 例乳腺癌患者术中放射治疗情况
图1 75 例早期乳腺癌患者行保留乳房手术联合术中放射治疗后的局部复发生存曲线
图2 75 例早期乳腺癌患者行保留乳房手术联合术中放射治疗后的无瘤生存曲线
表3 4 例乳腺癌复发患者的临床特征
[1]
Fisher B, Anderson S, Bryant J, et al.Twenty-year follow-up of a randomized trial comparing total mastectomy, lumpectomy,and lumpectomy plus irradiation for the treatment of invasive breast cancer [J].N Engl J Med,2002,347(16):1233-1241.
[2]
Veronesi U, Cascinelli N, Mariani L, et al.Twenty-year follow-up of a randomized study comparing breast-conserving surgery with radical mastectomy for early breast cancer [J].N Engl J Med,2002,347(16):1227-1232.
[3]
Jones HA, Antonini N, Hart AA, et al.Impact of pathological characteristics on local relapse after breast-conserving therapy:a subgroup analysis of the EORTC boost versus no boost trial[J].J Clin Oncol,2009,27(30):4939-4947.
[4]
Barry M, Sacchini V.Evaluating the role of intra-operative radiation therapy in the modern management of breast cancer[J].Surg Oncol,2012,21(4): e159-163.
[5]
Sawaki M, Sato S, Noda S, et al.Phase Ⅰ/Ⅱstudy of intraoperative radiotherapy for early breast cancer in Japan[J].Breast Cancer,2012,19(4):353-359.
[6]
Kimple RJ, Klauber-DeMore N, Kuzmiak CM, et al.Cosmetic outcomes for accelerated partial breast irradiation before surgical excision of early-stage breast cancer using single-dose intraoperative radiotherapy [J].Int J Radiat Oncol Biol Phys,2011,79(2):400-407.
[7]
Shaitelman SF,Kim LH.Accelerated partial-breast irradiation:the current state of our knowledge [J].Oncology, 2013,27(4):329-342.
[8]
郑一琼,李席如,李荣.乳腺癌保乳综合治疗的研究进展[J/CD].中华乳腺病杂志:电子版,2008,2(2):190-201.
[9]
Ash RB, Williams VL, Wagman LD, et al.Intraoperative radiotherapy for breast cancer: its perceived simplicity [J].Oncology (Williston Park),2013,27(2):107-113.
[10]
Lemanski C, Azaria D.Intraoperative radiotherapy given as a boost for early breast cancer: long-term clinical and cosmetic results [J].Intl J Radiat Oncol Biol Phys, 2006, 64(5):1410-1415.
[11]
Fastner G, Sedlmayer F,Merz F,et al.IORT with electrons as boost strategy during breast conserving therapy in limited stage breast cancer: long term results of an ISIORT pooled analysis[J].Radiother Oncol,2013,108(2):279-286.
[12]
Veronesi U, Orecchia R, Luini A, et al.Intraoperative radiotherapy during breast conserving surgery: a study on 1822 cases treated with electrons [J].Breast Cancer Res Treat,2010,124(1):141-151.
[13]
Vaidya JS, Wenz F, Bulsara M, et al.Risk-adapted targeted intraoperative radiotherapy versus whole-breast radiotherapy for breast cancer: 5-year results for local control and overall survival from the TARGIT-A randomised trial [J].Lancet,2014,383(9917):603-613.
[14]
Kimple RJ, Klauber-DeMore N, Kuzmiak CM, et al.Local control following single-dose intraoperative radiotherapy prior to surgical excision of early-stage breast cancer [J].Ann Surg Oncol,2011,18(4):939-945.
[15]
Vanderwalde NA, Jones EL, Kimple RJ, et al.Phase 2 study of pre-excision single-dose intraoperative radiation therapy for early-stage breast cancers: six-year update with application of the ASTRO accelerated partial breast irradiation consensus statement criteria [J].Cancer,2013,119(9):1736-1743.
[16]
Smith BD, Arthur DW, Buchholz TA, et al.Accelerated partial breast irradiation consensus statement from the American Society for Radiation Oncology (ASTRO) [J].Int J Radiat Oncol Biol Phys,2009,74(4):987-1001.
[17]
Polgár C, Van Limbergen E, Pötter R, et al.Patient selection for accelerated partial-breast irradiation (APBI) after breastconserving surgery: recommendations of the Groupe Européen de Curiethérapie-European Society for Therapeutic Radiology and Oncology (GEC-ESTRO) breast cancer working group based on clinical evidence (2009) [J].Radiother Oncol,2010,94(3):264-273.
[1] 李洋, 蔡金玉, 党晓智, 常婉英, 巨艳, 高毅, 宋宏萍. 基于深度学习的乳腺超声应变弹性图像生成模型的应用研究[J/OL]. 中华医学超声杂志(电子版), 2024, 21(06): 563-570.
[2] 周荷妹, 金杰, 叶建东, 夏之一, 王进进, 丁宁. 罕见成人肋骨郎格汉斯细胞组织细胞增生症被误诊为乳腺癌术后骨转移一例[J/OL]. 中华乳腺病杂志(电子版), 2024, 18(06): 380-383.
[3] 河北省抗癌协会乳腺癌专业委员会护理协作组. 乳腺癌中心静脉通路护理管理专家共识[J/OL]. 中华乳腺病杂志(电子版), 2024, 18(06): 321-329.
[4] 刘晨鹭, 刘洁, 张帆, 严彩英, 陈倩, 陈双庆. 增强MRI 影像组学特征生境分析在预测乳腺癌HER-2 表达状态中的应用[J/OL]. 中华乳腺病杂志(电子版), 2024, 18(06): 339-345.
[5] 张晓宇, 殷雨来, 张银旭. 阿帕替尼联合新辅助化疗对三阴性乳腺癌的疗效及预后分析[J/OL]. 中华乳腺病杂志(电子版), 2024, 18(06): 346-352.
[6] 邱琳, 刘锦辉, 组木热提·吐尔洪, 马悦心, 冷晓玲. 超声影像组学对致密型乳腺背景中非肿块型乳腺癌的诊断价值[J/OL]. 中华乳腺病杂志(电子版), 2024, 18(06): 353-360.
[7] 程燕妮, 樊菁, 肖瑶, 舒瑞, 明昊, 党晓智, 宋宏萍. 乳腺组织定位标记夹的应用与进展[J/OL]. 中华乳腺病杂志(电子版), 2024, 18(06): 361-365.
[8] 涂盛楠, 胡芬, 张娟, 蔡海峰, 杨俊泉. 天然植物提取物在乳腺癌治疗中的应用[J/OL]. 中华乳腺病杂志(电子版), 2024, 18(06): 366-370.
[9] 韩萌萌, 冯雪园, 马宁. 乳腺癌改良根治术后桡神经损伤1例[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 117-118.
[10] 李华志, 曹广, 刘殿刚, 张雅静. 不同入路下行肝切除术治疗原发性肝细胞癌的临床对比[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 52-55.
[11] 高杰红, 黎平平, 齐婧, 代引海. ETFA和CD34在乳腺癌中的表达及与临床病理参数和预后的关系研究[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 64-67.
[12] 张志兆, 王睿, 郜苹苹, 王成方, 王成, 齐晓伟. DNMT3B与乳腺癌预后的关系及其生物学机制[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(06): 624-629.
[13] 王玲艳, 高春晖, 冯雪园, 崔鑫淼, 刘欢, 赵文明, 张金库. 循环肿瘤细胞在乳腺癌新辅助及术后辅助治疗中的应用[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(06): 630-633.
[14] 赵林娟, 吕婕, 王文胜, 马德茂, 侯涛. 超声引导下染色剂标记切缘的梭柱型和圆柱型保乳区段切除术的效果研究[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(06): 634-637.
[15] 许月芳, 刘旺, 曾妙甜, 郭宇姝. 多粘菌素B和多粘菌素E治疗外科多重耐药菌感染临床疗效及安全性分析[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(06): 700-703.
阅读次数
全文


摘要