摘要
目的比较乳腺癌保乳术后调强放疗(IMRT)与三维适形放疗(3D-CRT)的疗效、不良反应及对基质金属蛋白酶-9(MMP-9)和基质金属蛋白酶组织抑制剂-1(TIMP-1)的影响。方法选择96例接受乳腺癌保乳术的女性患者,按照随机数字表法将患者随机分为对照组和观察组,每组各48例。对照组予以3D-RCT,观察组予以IMRT,处方剂量均为50 Gy/25次。比较两组的照射剂量、不良反应、美容效果及治疗前后的血清MMP-9和TIMP-1水平。结果观察组计划靶区(PTV)的V105%、V110%及V115%明显低于对照组(P﹤0.01),观察组患侧肺脏及左侧病灶者心脏接受的照射剂量明显低于对照组(P﹤0.01);观察组的皮肤反应率为12.5%(6/48),低于对照组的29.2%(14/48),差异有统计学意义(P﹤0.05);观察组美容优良率为97.9%(47/48),高于对照组的83.3%(40/48),差异有统计学意义(P﹤0.05)。放疗后,两组患者的MMP-9及MMP-9/TIMP-1均较本组治疗前降低,但组间比较差异无统计学意义(P﹥0.05)。结论与3D-CRT相比,IMRT的PTV适形度和剂量均匀性较好,可降低危及器官的受照剂量,皮肤反应较少且美容效果好,值得临床推广。
Objective To compare the effect, toxicity, and impact on MMP-9 and TIMP- 1 when intensity.modulated radiation therapy （IMRT） and 3D conformal radiation therapy （3D-CRT）were administered after breast-conserving sur- gery. Method 96 eases of breast cancer patients who had accepted breast-conserving surgery were randomized as con- trol group （48 cases） and study group （48 cases）, respectively. The control group received 3D-RCT, while the study group had IMRT, with a same prescription dose of 50 Gy/25 fractions after surgery. The dose distribution, toxicity and cosmetic outcome were compared, the serum level of MMP-9 and TIMP-1 before and after treatment were determined. Result In study group, the planning target volume （PTV） V105%, V110% and V115% were lower, the radiation dose of ipsilateral lung and heart were lower compared with that of the control group （P〈0.01）, The incidence of skin toxieities in study group was 12.5% （6/48）, which was lower than that in control group at 29 2% （14/48） （/）〈0.05）. The rate of good cosmet- ic outcome in study group was 97.9% （47/48）, higher than that in control group at 83.3% （40/48） （P〈0.05）. After radia- tion, the serum level of MMP-9 and MMP.9/TIMP, 1 deceased greatly, but there was no significant differences between the two groups （P〉0.05）. Conclusion Compared with 3D-CRT. IMRT is superior in homogeneity and conformal index, which reduces the dose exposure of non-targeted organs, with less skin toxieities and acceptable cosmetic outcome.
出处
《癌症进展》
2017年第3期321-324,共4页
Oncology Progress
关键词
乳腺癌保乳术
调强放疗蕾三维适形放疗
MMP-9
TIMP-1
breast-comerving surgery
intensity-moduiated radiation therapyi 3D conformal radiation therapy
MMP-9
TIMP-1
