乳腺癌保留乳房手术联合术中放射治疗60 例近期疗效观察

doi:10.3877/cma.j.issn.1674-0807.2017.01.003

目的

总结乳腺癌保留乳房手术(简称保乳手术)联合INTRABEAM 术中放射治疗的近期疗效、不良反应及美容效果。

方法

回顾性分析兰州军区兰州总医院乳腺外科2012 年12 月至2015 年6 月收治的60 例行保乳手术联合INTRABEAM 术中放射治疗乳腺癌患者的临床资料。所有患者术中经病理学确认切缘阴性后实施INTRABEAM 术中放射治疗。分析患者术后DFS 率、不良反应及美容效果。采用Kaplan-Meier 法绘制DFS 曲线。

结果

中位随访24 个月(12 ～42 个月),患者术后2 年局部复发率为5%(3/60),术后2 年DFS 率为95%。本组患者中,8 例(13.3%,8/60)出现放射治疗后乳腺纤维化,4 例(6.7%,4/60)出现乳腺脂肪液化坏死,1 例(1.7%,1/60)出现乳房血肿。患者术后美容效果总体满意率为90.0%(54/60),其中优秀率和良好率分别为53.3%(32/60)和36.7%(22/60)。

结论

乳腺癌保乳手术联合INTRABEAM 术中放射治疗近期疗效和美容效果良好,不良反应少,值得临床推广。

关键词: 乳腺肿瘤, 乳房切除术, 皮下, 监测, 手术中, 放射疗法, 计算机辅助

Objective

To evaluate the short-term effect,adverse reaction and cosmetic result of breast conserving surgery combined with INTRABEAM intraoperative radiotherapy in breast cancer patients.

Methods

We retrospectively analyzed the clinical data of 60 patients who underwent breast conserving surgery combined with INTRABEAM intraoperative radiotherapy in Department of Breast Surgery, General Hospital of Lanzhou Military Command from December 2012 to June 2015. All patients received breast conserving surgery,then INTRABEAM intraoperative radiotherapy was given after postoperative pathology confirmed clear surgical margins. The DFS,adverse reaction and cosmetic result were analyzed. Kaplan-Meier method was used to draw DFS curve.

Results

The median follow-up was 24 months (12-42 months). The local recurrence rate was 5% (3/60) two years after operation. The two-year DFS was 95%. There were 8 patients (13.3%, 8/60)with breast fibrosis after radiotherapy,4 (6.7%,4/60) with fat liquefaction and 1 (1.7%,1/60) with breast hematoma. The satisfactory rate of patients in cosmetic effect was 90.0% (54/60), in which the excellent rate and the good rate were 53.3% (32/60) and 36.7% (22/60) respectively.

Conclusion

Breast conserving surgery combined with INTRABEAM intraoperative radiotherapy has beneficial short-term effect, favorable cosmetic result and a few adverse reactions, worthy of clinical practice.

Key words: Breast neoplasms, Mastectomy, subcutaneous, Monitoring, intraoperative, Radiotherapy, computer-assisted

表1 60 例乳腺癌患者临床资料

临床病理因素	例数	构成比(%)
年龄
≤50岁	26	43.3
＞50岁	34	56.7
乳腺癌T分期
T₁	36	60.0
T₂	24	40.0
乳腺癌N分期
N₀	46	76.7
N₁	14	23.3
病理类型
浸润性导管癌	52	86.7
其他^a	8	13.3
组织学分级
1级	28	46.7
2级	20	33.3
3级	8	13.3
未知	4	6.7
分子分型
luminal A型	32	53.3
luminal B型	16	26.7
HER-2过表达型	5	8.3
三阴性乳腺癌	7	11.7

表1 60 例乳腺癌患者临床资料

临床病理因素	例数	构成比(%)
年龄
≤50岁	26	43.3
＞50岁	34	56.7
乳腺癌T分期
T₁	36	60.0
T₂	24	40.0
乳腺癌N分期
N₀	46	76.7
N₁	14	23.3
病理类型
浸润性导管癌	52	86.7
其他^a	8	13.3
组织学分级
1级	28	46.7
2级	20	33.3
3级	8	13.3
未知	4	6.7
分子分型
luminal A型	32	53.3
luminal B型	16	26.7
HER-2过表达型	5	8.3
三阴性乳腺癌	7	11.7

图1 乳腺癌患者行术中放射治疗(IORT) 注:a 图为INTRABEAM IORT 设备主机;b 图所示不同型号放射治疗限光筒,应根据术后残腔大小选择适宜型号的限光筒;c 图所示,术中将限光筒球头端固定于瘤床,并保护周围乳房皮肤

图2 60 例乳腺癌患者行术中放射治疗后不良反应的构成情况

图3 60 例乳腺癌患者行术中放射治疗后的无瘤生存曲线

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Short-term effect of breast conserving surgery combined with intraoperative radiotherapy in 60 patients with breast cancer

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Short-term effect of breast conserving surgery combined with intraoperative radiotherapy in 60 patients with breast cancer