早期左侧乳腺癌保乳术后大分割放疗同期瘤床加量的安全性及心脏亚结构剂量评估的重要性研究

章倩; 方晓燕; 刘娟; 刘进; 程蕾蕾; 孙菁

doi:10.19401/j.cnki.1007-3639.2022.05.008

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早期左侧乳腺癌保乳术后大分割放疗同期瘤床加量的安全性及心脏亚结构剂量评估的重要性研究

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- 早期左侧乳腺癌保乳术后大分割放疗同期瘤床加量的安全性及心脏亚结构剂量评估的重要性研究
- Study on the safety of simultaneous integrated boost and the importance of cardiac substructural dose assessment of hypofractionated radiotherapy after early left breast cancer breast-conserving surgery
- 中国癌症杂志 2022年32卷第5期页码：427-435
- 作者机构：
  
  1. 复旦大学附属中山医院放疗科,上海 200032
  2. 复旦大学附属中山医院心超科,上海 200032
- 作者简介：
  
  [ "章倩（ORCID: 0000-0002-7607-9873）,博士,主治医师 E-mail: zhang.qian3@zs-hospital.sh.cn" ]
  孙菁（ORCID: 0000-0003-0138-1880）,硕士,副主任医师 E-mail: sun.jing@zs-hospital.sh.cn
- 基金信息：
  
  复旦大学附属中山医院青年基金(2017ZSQN35)
- DOI：10.19401/j.cnki.1007-3639.2022.05.008
  中图分类号： R737.9
- 收稿：2022-01-11，
  
  修回：2022-02-24，
  
  纸质出版：2022-05-30
- 稿件说明：
移动端阅览
章倩, 方晓燕, 刘娟, 等. 早期左侧乳腺癌保乳术后大分割放疗同期瘤床加量的安全性及心脏亚结构剂量评估的重要性研究[J]. 中国癌症杂志, 2022,32(5):427-435.

Qian ZHANG, Xiaoyan FANG, Juan LIU, et al. Study on the safety of simultaneous integrated boost and the importance of cardiac substructural dose assessment of hypofractionated radiotherapy after early left breast cancer breast-conserving surgery[J]. China Oncology, 2022, 32(5): 427-435.
章倩, 方晓燕, 刘娟, 等. 早期左侧乳腺癌保乳术后大分割放疗同期瘤床加量的安全性及心脏亚结构剂量评估的重要性研究[J]. 中国癌症杂志, 2022,32(5):427-435. DOI： 10.19401/j.cnki.1007-3639.2022.05.008.

Qian ZHANG, Xiaoyan FANG, Juan LIU, et al. Study on the safety of simultaneous integrated boost and the importance of cardiac substructural dose assessment of hypofractionated radiotherapy after early left breast cancer breast-conserving surgery[J]. China Oncology, 2022, 32(5): 427-435. DOI： 10.19401/j.cnki.1007-3639.2022.05.008.

摘要

背景与目的：

早期乳腺癌保乳术后辅助大分割放疗已被指南推荐

但大分割放疗同期瘤床加量是否可行目前尚无定论。本随机对照研究对大分割同期瘤床加量和常规分割同期瘤床加量两种放疗计划的心脏剂量学参数和心超指标等进行比较

以评估前者在心脏毒性方面的安全性。

方法：

纳入复旦大学附属中山医院2017年3月

#x02014;2018年3月收治的符合入组标准的早期乳腺癌保乳术后左侧乳腺癌患者40例

随机分为两组

20例制定大分割同期瘤床加量放疗计划（全乳放疗剂量4 005 cGy/15次

同期瘤床加量至4 500 cGy/15次）

20例制定常规分割同期瘤床加量放疗计划（全乳放疗剂量5 000 cGy/25次

同期瘤床加量至6 000 cGy/25次）

比较两组患者的心脏剂量学参数和心脏超声检查指标

剂量学参数包括全心脏、左心室、右心室、右室游离壁、室间隔和冠状动脉左前降支（left anterior descending

LAD）的平均剂量（

mean

）以及各结构受到5~35 Gy照射的相对体积分数（

5 Gy

35 Gy

）。心超随访指标包括主动脉根部直径、左房内径、左室舒张末内径、左室收缩末内径、室间隔厚度、左室后壁厚度、肺动脉收缩压、左室射血分数、E峰、A峰、E峰减速时间（E-peak deceleration time

DT）、E、A、E/A和S波峰值。此外

对两组放疗后乳房的美容效果也进行评估。

结果：

大分割组和常规分割组全心脏的

mean

分别为（471.86

#x000b1;170.54）和（733.07

#x000b1;79.11）cGy（

0.05）

全心脏的

20 Gy

为（3.63

#x000b1;1.74）%和（8.43

#x000b1;0.74）%（

0.05）

30 Gy

为（1.55

#x000b1;1.15）%和（4.48

#x000b1;1.01）%（

0.05）

LAD的

mean

分别为（1 250.17

#x000b1;600.33）和（1 847.20

#x000b1;933.23）cGy（

0.05）

左心室的

mean

分别（908.64

#x000b1;865.60）和（946.93

#x000b1;116.13）cGy（

0.05）

右心室的

mean

分别为（590.37

#x000b1;197.99）和（905.73

#x000b1;180.82）cGy（

0.05）

右室游离壁的

mean

分别为（939.40

#x000b1;284.23）和（1 597.30

#x000b1;446.31）cGy（

0.05）

室间隔的

mean

分别为（637.49

#x000b1;248.19）和（988.60

#x000b1;159.77）cGy（

0.05）。随访1年

大分割组与常规分割组相比

心超指标均在正常区间

差异均无统计学意义（

0.05）。两组美容效果也无显著差异（

0.05）。

结论：

大分割同期瘤床加量放疗计划较常规分割计划可以显著降低全心脏和部分心脏亚结构的受照剂量

随访1年心超指标无异常

临床采用本研究所用的剂量分割方式是安全可行的。仅限制全心脏剂量无法有效保护LAD

建议勾画心脏亚结构并单独限制剂量以更好地保护心脏。

Abstract

Background and purpose:

Adjuvant radiotherapy for breast cancer after early breast-conserving surgery has been recommended by the guidelines. However

the feasibility of hypofractionated radiotherapy with simultaneous integrated boost is not available. In this randomized controlled study

the cardiac dosimetry parameters and cardiac ultrasound indexes of the two radiotherapy plans were compared to evaluate the safety of hypofractionated radiotherapy with simultaneous integrated boost plan in terms of cardiotoxicity.

Methods:

A total of 40 patients with breast cancer who received breast-conserving surgery were selected in Zhongshan Hospital

Fudan University from March 2017 to March 2018. They were randomly divided into two groups

including 20 patients reveiving hypofractionated radiotherapy with simultaneous integrated boost plan (whole breast 4 005 cGy/15 Fx

tumor bed 4 500 cGy/15 Fx) and 20 patients reveiving conventional fractionation with simultaneous integrated boost plan (whole breast 5 000 cGy/25 Fx

tumor bed 6 000 cGy/25 Fx). The cardiac dosimetric parameters and cardiac ultrasound indexes of the two groups were compared. The dosimetric parameters included the average doses (

mean

) of the whole heart

left ventricle

right ventricle

right ventricular free wall

ventricular

septum and left anterior descending (LAD) coronary artery

and the relative volume fraction of each structure irradiated by 5-35 Gy (

5 Gy

-V

35 Gy

). The follow-up indexes of echocardiography included aortic root diameter

left atrial diameter

left ventricular end diastolic diameter

left ventricular end systolic diameter

ventricular septal thickness

left ventricular posterior wall thickness

pulmonary artery systolic pressure

left ventricular ejection fraction

E peak

A peak

E-peak deceleration time (DT)

E/A and S wave peak. In addition

the cosmetic effect on breast after radiotherapy in the two groups was also evaluated.

Results:

mean

of the whole heart in the hypofractionated group and the conventional group were (471.86

#x000b1;170.54) and (733.07

#x000b1;79.11) cGy (

0.05); V

20 Gy

of the whole heart was (3.63

#x000b1;1.74) and (8.43

#x000b1;0.74)% (

0.05)

and V30 Gy was (1.55

#x000b1;1.15) and (4.48

#x000b1;1.01)% (

0.05).

mean

of LAD were (1 250.17

#x000b1;600.33) and (1 847.20

#x000b1;933.23) cGy (

0.05);

mean

of left ventricle were (908.64

#x000b1;865.60)

(946.93

#x000b1;116.13) cGy (

0.05).

mean

of right ventricle were (590.37

#x000b1;197.99)

(905.73

#x000b1;180.82) cGy (

0.05);

mean

of right ventricular free wall were (939.40

#x000b1;284.23)

(1 597.30

#x000b1;446.3) cGy (

0.05);

mean

of ventricular septum were (1 637.49

#x000b1;248.19)

(988.60

#x000b1;159.77) cGy (

0.05). After one year of follow-up

the cardiac ultrasound indexes in the hypofractionat

ed group and the conventional group were in the normal range

and there was no significant difference between the two groups (

0.05). There was no significant difference in cosmetic effect between the two groups (

0.05).

Conclusion:

Compared with the conventional fractionation plan

hypofractionated radiotherapy with simultaneous integrated boost significantly reduced the radiation dose of the whole heart and some cardiac substructures

and there were no abnormal cardiac ultrasound indexes during one-year follow-up. The dose fractionation method in this study is safe and feasible. Limiting the whole heart dose alone can not effectively protect LAD

so it is recommended to outline the cardiac substructure and limit the dose alone to better protect the heart.

关键词

Keywords

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