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目的:探索乳腺癌根治术后大分割放疗的远期疗效和副作用。方法:利用随机分组的方法,将578例乳腺癌根治术后患者分为常规分割放疗组(A组)、3 Gy分割组(B组)和大分割组(C组)3组进行放疗,并进行长期随访观察和随访资料分析。A组放疗方法为:2.0 Gy/次,1次/d,5次/w,总剂量50 Gy;B组为:3Gy/次,1次/d,5次/周,总剂量45 Gy;C组为:5 Gy第1、3 d,6.5 Gy/15、17 d,总剂量为23 Gy。结果:所有患者均完成了治疗,随访时间15～18年,中位随访时间16.4年,死亡170例,失访36例,随访率93%。死亡原因多为远处转移或局部复发并远处转移。9例患者死于心脏事件。治疗期间,A、B组123例有明显放射反应,表现为乏力、食欲不振、轻度恶心和不同程度的吞咽不适、梗阻或吞咽疼痛。C组除放疗当日和次日有轻度乏力、恶心外,其余无不良反应。A、B组疗中或疗后均有不同程度的皮肤色素沉着,部分有干性脱皮和湿性脱皮。C组仅有轻质皮肤发红和色素沉着改变,皮肤变化与A、B组差异有统计学意义(P<0.001)。1、2级放射性肺炎、肺纤维化和上肢水肿A、B组与C组间也存在差异有统计学意义(P<0.001),3级肺炎、胸壁纤维化、肋骨骨折和心脏事件等C组很低,差异具有统计学意义。各组死亡率、复发率和远处转移率均相似,差异没有显著性。结论:B、C两组放疗方法可获得与常规方法相似的效果,特别是C组方式,明显减轻了放疗反应,缩短了治疗时间。
Objective: To explore the long-term efficacy and side effects of large fractionated radiotherapy after radical mastectomy. METHODS: Randomized subgrouping methods were used to divide 578 patients after radical mastectomy into radiation therapy group (group A), 3 Gy segmentation group (group B) and large segmentation group (group C). Long-term follow-up observation and follow-up data analysis. The radiotherapy methods in group A were: 2.0 Gy/time, 1 time/d, 5 times/w, total dose 50 Gy; B group: 3 Gy/time, 1 time/d, 5 times/week, total dose 45 Gy; C The groups were: 1st, 3rd day of 5 Gy, 6.5 Gy/15, 17 d, and the total dose was 23 Gy. Results: All the patients completed the treatment. The follow-up time was 15 to 18 years. The median follow-up time was 16.4 years. 170 patients died and 36 were lost. The follow-up rate was 93%. The cause of death is mostly distant metastasis or local recurrence and distant metastasis. Nine patients died of cardiac events. During the treatment period, 123 patients in group A and B had significant radiological reactions, manifesting as fatigue, loss of appetite, mild nausea, and varying degree of swallowing discomfort, obstruction or swallowing pain. In Group C, except for mild fatigue and nausea on the day of radiotherapy and the following day, there were no adverse reactions. In group A and B, there were different degrees of skin pigmentation during or after treatment, some of which were dry and wet. In group C, only light skin redness and pigmentation were changed, and there was a statistically significant difference between skin changes and groups A and B (P<0.001). Grade 1 and 2 radiation pneumonitis, pulmonary fibrosis, and upper limb edema also had statistically significant differences between groups A and B (P<0.001), grade 3 pneumonia, chest wall fibrosis, rib fractures, and cardiac events. Very low, the difference was statistically significant. The mortality, recurrence rate, and distant metastasis rate were similar in each group, and the difference was not significant. Conclusion: The two groups of radiotherapy methods B and C can obtain similar results to the conventional methods, especially in the C group, which significantly reduces the radiotherapy response and shortens the treatment time.