ⅱ期乳癌术后胸壁电子束弧形照射临床观察.docVIP

Ⅱ期乳癌术后胸壁电子束弧形照射临床观察 nbsp;nbsp;nbsp;nbsp;nbsp;nbsp;nbsp;nbsp;nbsp;nbsp;nbsp; 作者：王迎选, 刚颖, 吴殿久, 何昌秀, 崔书祥, 王所亭 【摘要】nbsp; 　　目的 分析应用电子束弧形照射技术对Ⅱ期乳癌根治术后放疗的临床效果。方法 对87例接受了乳癌改良根治术后的Ⅱ期患者实施了术后放疗。靶区为患侧锁骨上、下淋巴引流区、腋窝、胸壁（包括手术疤痕），肿瘤位于内侧象限者，加以内乳区照射。内乳区、胸壁采用电子束弧形照射。结果 全组病例5年存活率为79.5%,5年无瘤存活率为76.4%,腋窝淋巴结阳性率＜20%组5年生存率为84.8%;＞20%组为73.1%(P＜0.001)。结论 ①实施根据胸廓外型和靶区深度调整并转换电子束能量的弧形照射，可以得到理想的靶区剂量分布，改善放疗效果，提高乳癌病人的局部肿瘤控制率，从而改善存活率及生存质量。②腋窝淋巴结阳性率＞20%提示预后较差，对此组病例应予以积极的综合治疗。 【关键词】nbsp; 乳腺癌　术后放疗　电子束弧形照射 　　Postmastectomynbsp; Electronbeamrotationnbsp; Irradiationnbsp;nbsp; innbsp;nbsp;nbsp; Stagenbsp;nbsp; Ⅱnbsp; Breastnbsp; Cancer 　　Abstract：Objectivenbsp;nbsp; Wenbsp; reviewnbsp; thenbsp;nbsp; resultsnbsp; withnbsp; thenbsp; electronbeamrotationnbsp; techniquenbsp; innbsp; stagenbsp; Ⅱnbsp; locallynbsp; advancednbsp; breastnbsp; cancernbsp; patients.Methodsnbsp; Fromnbsp; 1993nbsp; tonbsp; 2001,87nbsp; patientsnbsp; withnbsp; stagenbsp; Ⅱnbsp; locallynbsp; advancednbsp; breastnbsp; cancernbsp; underwentnbsp; electronbeamrotationnbsp; irradiationnbsp; ofnbsp; thenbsp;nbsp; chestnbsp; wallnbsp; andnbsp;nbsp; internalnbsp; mammarynbsp; lymphnbsp; nodesnbsp; withnbsp; dailynbsp; fractionsnbsp; ofnbsp; 200cGynbsp; pernbsp; daynbsp; tonbsp; 40～50nbsp; Gynbsp; totalnbsp; dosenbsp; afternbsp; modifiednbsp; radicalnbsp; mastectomynbsp; andnbsp;nbsp; axillarynbsp; lymphnbsp; nodenbsp; dissection.Resultsnbsp; Afternbsp; anbsp; mediannbsp; followupnbsp; ofnbsp; 44nbsp; months,nbsp; thenbsp; 5yearnbsp; overallnbsp; survivalnbsp; wasnbsp; 79.5%,nbsp; diseasefreenbsp; survival wasnbsp; 76.4% (KaplenMeiernbsp; analysis). Significantnbsp; predictorsnbsp; ofnbsp; poornbsp; localnbsp; tumornbsp; controlnbsp; wasnbsp; involvednbsp; axillarynbsp; lymphnbsp; nodes＞20%, thenbsp; 5yearnbsp; overallnbsp; survivalnbsp; wasnbsp; 73.1% vsnbsp; 84.8%nbsp; withnbsp; involvednbsp; axillarynbsp; lymphnbsp; nodes＜20% (P＜0.001).Conclusionnbsp; ①Innbsp; highrisknbsp; breastnbsp; cancernbsp;