术中光子线与术后外照射在早期乳腺癌保留乳房手术瘤床加量放疗中的近期疗效比较

doi:10.3877/cma.j.issn.1674-0793.2020.05.004

中华普通外科学文献(电子版) ›› 2020, Vol. 14 ›› Issue (05) : 336 -340. doi: 10.3877/cma.j.issn.1674-0793.2020.05.004

所属专题：文献；

论著

术中光子线与术后外照射在早期乳腺癌保留乳房手术瘤床加量放疗中的近期疗效比较

于亮¹, 叶润仪¹, 单臻¹, 张赟建¹, 陈瑞莞², 聂大红², 林颖¹^,^†(

)

^1. 510080　广州，中山大学附属第一医院甲状腺乳腺外科
^2. 510080　广州，中山大学附属第一医院放射治疗科

收稿日期:2020-04-08 出版日期:2020-10-01
通信作者: 林颖
基金资助:
中山大学临床医学研究5010计划资助项目(2016007)

Comparison intraoperative radiotherapy with external radiotherapy as a boost of tumor bed in breast-conserving surgery of early breast cancer

Liang Yu¹, Runyi Ye¹, Zhen Shan¹, Yunjian Zhang¹, Ruiwan Chen², Dahong Nie², Ying Lin¹^,^†()

^1. Department of Thyroid and Breast Surgery, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China
^2. Department of Radiation Oncology, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China

Received:2020-04-08 Published:2020-10-01
Corresponding author: Ying Lin
About author:
Corresponding author: Lin Ying, Email: linying3@mail.sysu.edu.cn

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于亮, 叶润仪, 单臻, 张赟建, 陈瑞莞, 聂大红, 林颖. 术中光子线与术后外照射在早期乳腺癌保留乳房手术瘤床加量放疗中的近期疗效比较[J]. 中华普通外科学文献(电子版), 2020, 14(05): 336-340.

Liang Yu, Runyi Ye, Zhen Shan, Yunjian Zhang, Ruiwan Chen, Dahong Nie, Ying Lin. Comparison intraoperative radiotherapy with external radiotherapy as a boost of tumor bed in breast-conserving surgery of early breast cancer[J]. Chinese Archives of General Surgery(Electronic Edition), 2020, 14(05): 336-340.

目的

比较早期乳腺癌保乳术后采用术中光子线对比术后外照射瘤床加量的安全性和可行性。

方法

回顾性分析2014年12月至2018年6月中山大学附属第一医院甲状腺乳腺外科收治的222例早期乳腺行保乳手术患者的临床资料，其中72例采用术中光子线瘤床加量（术中放疗组），150例采用术后外照射瘤床加量（术后放疗组）。所有患者术后均行全乳±淋巴引流区外照射放疗，50 Gy/25 Fr。观察术后两组患者的不良反应、美容效果及近期疗效。

结果

中位随访35个月（11~52个月），术中放疗组比术后放疗组有更低的乳腺纤维化发生率（2.8% vs 13.3%，χ²=6.071，P=0.014），但术后血肿的发生率更高（5.6% vs 0，P=0.015）。术后感染、坏死而引起切口延迟愈合、照射野内中度以上的乳腺疼痛，在两组间差异无统计学意义。术中放疗组和术后放疗组总体不良反应的发生率分别为13.9%和16.0%，美容效果优良率分别为83.3%（60/72）和89.3%（134/150），术后3年的局部复发率分别为0（0/72）和1.3%（2/150），差异均无统计学意义。

结论

与术后外照射瘤床加量相比较，早期乳腺癌保乳术采用术中光子线的不良反应、美容效果和近期疗效相似。

关键词: 乳腺肿瘤, 放疗疗法，术中, 治疗结果

Objective

To compare the adverse reaction and cosmetic effect of intraoperative radiotherapy using mobile photon beam with post-operative external radiotherapy as a boost to the tumor bed in patients with early-stage breast cancer receiving breast conserving surgery.

Methods

The clinical data of breast cancer patients who underwent breast-conserving surgery from December 2014 to June 2018 were analyzed retrospectively. Patients were divided into intraoperative radiotherapy (72 cases) and post-operative external radiotherapy (150 cases) groups. All patient were treated with radiation therapy to whole breast ± regional nodes at the dose of 50 Gy in 25 fractions. The adverse reaction and cosmetic effect were followed up as well as postoperative recurrence.

Results

Median follow-up period was 35 months (11-52 months). Patients developed less breast fibrosis in intraoperative radiotherapy group compared with post-operative external radiotherapy group (2.8% vs 13.3%, χ²=6.071, P=0.014). However, patients developed more postoperative hematoma in intraoperative radiotherapy group compared with post-operative external radiotherapy group (5.6% vs 0, P=0.015). There is no significant difference between the postoperative infection and necrosis resulted in delayed incision healing and moderate or above breast pain in the irradiation field. The overall incidence of adverse reactions was 13.9% and 16.0% respectively, and the difference was not statistically significant. Patients had excellent or good cosmetic outcome was 83.3% in intraoperative radiotherapy group and 89.3% in post-operative external radiotherapy group. The 3-year local recurrentce rate was 0 in intraoperative radiotherapy group and 1.3% in post-operative external radiotherapy group.

Conclusion

Compared with postoperative external radiotherapy as a boost to the tumor bed, the intraoperative radiotherapy after breast-conserving surgery shows acceptable adverse reaction and similar cosmetic outcome as well as short-term efficacy.

Key words: Breast neoplasms, Radiothery, intraoperative, Treatment outcome

表1 两组患者一般临床资料比较[例(%)]

项目		术中放疗组(72例)	术后放疗组(150例)	统计量	P值
年龄(岁)		?	?	H_C=-0.179	0.858
?	<40	8(11.1)	24(16.0)	?	?
?	40~60	60(83.3)	108(72.0)	?	?
?	>60	4(5.6)	18(12.0)	?	?
T分期		?	?	H_C=-1.221	0.222
?	Tis	8(11.1)	22(14.7)	?	?
?	T1	48(66.7)	104(69.3)	?	?
?	T2	16(22.2)	24(16.0)	?	?
N分期		?	?	H_C=-1.409	0.159
?	N0	54(75.0)	124(82.7)	?	?
?	N1	12(16.7)	20(13.3)	?	?
?	N2	6(8.3)	6(4.0)	?	?
病理类型		?	?	χ²=1.247	0.536
?	浸润性导管癌	56(77.8)	106(70.6)	?	?
?	导管内癌	8(11.1)	22(14.7)	?	?
?	其他	8(11.1)	22(14.7)	?	?
组织学分级		?	?	χ²=1.259	0.868
?	1级	16(22.2)	28(18.7)	?	?
?	2级	26(36.1)	60(40.0)	?	?
?	3级	16(22.2)	30(20.0)	?	?
?	导管内癌	8(11.1)	22(14.7)	?	?
?	未知	6(8.3)	10(6.6)	?	?
ER		?	?	χ²=1.758	0.185
?	阳性	62(86.1)	118(78.7)	?	?
?	阴性	10(13.9)	32(21.3)	?	?
PR		?	?	χ²=0.941	0.332
?	阳性	58(80.6)	112(74.7)	?	?
?	阴性	14(19.4)	38(25.3)	?	?
HER-2		?	?	χ²=1.544	0.214
?	阳性	12(16.7)	36(24.0)	?	?
?	阴性	60(83.3)	114(76.0)	?	?

表1 两组患者一般临床资料比较[例(%)]

项目		术中放疗组(72例)	术后放疗组(150例)	统计量	P值
年龄(岁)		?	?	H_C=-0.179	0.858
?	<40	8(11.1)	24(16.0)	?	?
?	40~60	60(83.3)	108(72.0)	?	?
?	>60	4(5.6)	18(12.0)	?	?
T分期		?	?	H_C=-1.221	0.222
?	Tis	8(11.1)	22(14.7)	?	?
?	T1	48(66.7)	104(69.3)	?	?
?	T2	16(22.2)	24(16.0)	?	?
N分期		?	?	H_C=-1.409	0.159
?	N0	54(75.0)	124(82.7)	?	?
?	N1	12(16.7)	20(13.3)	?	?
?	N2	6(8.3)	6(4.0)	?	?
病理类型		?	?	χ²=1.247	0.536
?	浸润性导管癌	56(77.8)	106(70.6)	?	?
?	导管内癌	8(11.1)	22(14.7)	?	?
?	其他	8(11.1)	22(14.7)	?	?
组织学分级		?	?	χ²=1.259	0.868
?	1级	16(22.2)	28(18.7)	?	?
?	2级	26(36.1)	60(40.0)	?	?
?	3级	16(22.2)	30(20.0)	?	?
?	导管内癌	8(11.1)	22(14.7)	?	?
?	未知	6(8.3)	10(6.6)	?	?
ER		?	?	χ²=1.758	0.185
?	阳性	62(86.1)	118(78.7)	?	?
?	阴性	10(13.9)	32(21.3)	?	?
PR		?	?	χ²=0.941	0.332
?	阳性	58(80.6)	112(74.7)	?	?
?	阴性	14(19.4)	38(25.3)	?	?
HER-2		?	?	χ²=1.544	0.214
?	阳性	12(16.7)	36(24.0)	?	?
?	阴性	60(83.3)	114(76.0)	?	?

表2 患者的急性放射性损伤发生情况[例(%)]

组别	例数	纤维化	血肿	感染	坏死	疼痛	总体
术中放疗组	72	2(2.8)	4(5.6)	6(8.3)	6(8.3)	0(0)	10(13.9)
术后放疗组	150	20(13.3)	0(0)	4(2.7)	4(2.7)	2(1.3)	24(16.0)
χ²值	?	6.071	-	3.632	3.632	-	0.167
P值	?	0.014	0.015	0.057	0.057	1.000	0.683

表2 患者的急性放射性损伤发生情况[例(%)]

组别	例数	纤维化	血肿	感染	坏死	疼痛	总体
术中放疗组	72	2(2.8)	4(5.6)	6(8.3)	6(8.3)	0(0)	10(13.9)
术后放疗组	150	20(13.3)	0(0)	4(2.7)	4(2.7)	2(1.3)	24(16.0)
χ²值	?	6.071	-	3.632	3.632	-	0.167
P值	?	0.014	0.015	0.057	0.057	1.000	0.683

图1 早期乳腺癌患者保乳手术后代表性图片　A为优异；B为良好；C为一般

[1]	Darby S, Mc Gale P, Correa C, et al. Effect of radiotherapy after breast-conserving surgery on 10-year recurrence and 15-year breast cancer death: Meta-analysis of individual patient data for 10,801 women in 17 randomised trials[J]. Lancet, 2011, 378(9804): 1707-1716.
[2]	Garreffa E, Hughes-Davies L, Russell S, et al. Definition of tumor bed boost in oncoplastic breast surgery: An understanding and approach[J]. Clin Breast Cancer, 2020, 20(4): e510-e515.
[3]	Kimple RJ, Klauber-De More 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.
[4]	Sawaki M, Sato S, Noda S, et al. Phase Ⅰ/Ⅱ study of intraoperative radiotherapy for early breast cancer in Japan[J]. Breast Cancer, 2012, 19(4): 353-359.
[5]	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.
[6]	Benda RK, Yasuda G, Sethi A, et al. Breast boost: are we missing the target?[J]. Cancer, 2003, 97(4): 905-909.
[7]	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.
[8]	Vaidya JS, Baum M, Tobias JS, et al. Long-term results of targeted intraoperative radiotherapy (Targit) boost during breast-conserving surgery[J]. Int J Radiat Oncol Biol Phys, 2011, 81(4): 1091-1097.
[9]	Bartelink H, Horiot JC, Poortmans P, et al. Recurrence rates after treatment of breast cancer with standard radiotherapy with or without additional radiation[J]. N Engl J Med, 2001, 345(19): 1378-1387.
[10]	Bentzen SM, Agrawal RK, Aird EG, et al. The UK Standardisation of Breast Radiotherapy (START) Trial A of radiotherapy hypofractionation for treatment of early breast cancer: A randomised trial[J]. Lancet Oncol, 2008,9(4): 331-341.
[11]	Valente SA, Shah C. The landmark series: adjuvant radiation therapy for breast cancer[J]. Ann Surg Oncol, 2020, 27(7): 2203-2211.
[12]	Belletti B, Vaidya JS, D'Andrea S, et al. Targeted intraoperative radiotherapy impairs the stimulation of breast cancer cell proliferation and invasion caused by surgical wounding[J]. Clin Cancer Res, 2008, 14(5): 1325-1332.
[13]	Kim MY, Oskarsson T, Acharyya S, et al. Tumor self-seeding by circulating cancer cells[J]. Cell, 2009, 139(7): 1315-1326.
[14]	Welzel G, Hofmann F, Blank E, et al. Health-related quality of life after breast-conserving surgery and intraoperative radiotherapy for breast cancer using low-kilovoltage X-rays[J]. Ann Surg Oncol, 2010, 17(Suppl 3): 359-367.
[15]	Fastner G, Reitsamer R, Urbanski B, et al. Toxicity and cosmetic outcome after hypofractionated whole breast irradiation and boost-IOERT in early stage breast cancer (HIOB): first results of a prospective multicenter trial (NCT01343459)[J]. Radiother Oncol, 2020, 146: 136-142.
[16]	Ahn SG, Bae SJ, Lee HW, et al. A phase Ⅱ study investigating the acute toxicity of targeted intraoperative radiotherapy as tumor-bed boost plus whole breast irradiation after breast-conserving surgery in Korean patients[J]. Breast Cancer Res Treat, 2019, 174(1): 157-163.
[17]	Blank E, Kraus-Tiefenbacher U, Welzel G, et al. Single-center long-term follow-up after intraoperative radiotherapy as a boost during breast-conserving surgery using low-kilovoltage x-rays[J]. Ann Surg Oncol, 2010, 17(Suppl 3): 352-358.
[18]	Vaidya JS, Joseph DJ, Tobias JS, et al. Targeted intraoperative radiotherapy versus whole breast radiotherapy for breast cancer (TARGIT-A trial): An international, prospective, randomised, non-inferiority phase 3 trial[J]. Lancet, 2010, 376(9735): 91-102.

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