Acute Side Effects And Psychological Influence Of Whole Breast Radiotherapy With Simultaneous Tumor Bed Boost On Patients With Breast Cancer After Breast-Conserving Surgery

Objectives To compare the side effects,cosmetic effects and psychological effects of different radiotherapy schemes in patients with early breast cancer after breast conserving surgery,including the scheme of hypofractionated whole-breast irradiation with simultaneous boost of the tumor bed,hypofractionated whole-breast irradiation with sequential boost of the tumor bed and the conventional fractionated radiotherapy.Methods The 156 patients with early breast cancer post breast-conserving surgery in Tangshan people's Hospital from June 2018 to October 2019,who need to receive the whole breast radiotherapy,were selected.To obtain the maximum inspection efficiency,the patients were randomly and equally divided into three groups by using SPSS17.0: the group of whole breast radiotherapy with simultaneous tumor bed boost(52 cases,dose:43.5Gy/2.9Gy/15 F for whole breast+49.5Gy/3.3Gy/15 F for tumor bed,simultaneously),the group of whole breast radiotherapy with sequential tumor bed boost(52 cases,dose:43.5Gy/2.9Gy/15 F for whole breast+8.7Gy/2.9Gy/3F for tumor bed,sequentially)and the group with conventional radiotherapy(52 cases,dose: 50Gy/2.0Gy/25 F for whole breast+10Gy/2.0Gy/5F for tumor bed,sequentially).1 According to Radiation Therapy Oncology Group(RTOG)criteria,the acute side effects on skin,lung and blood among the tree groups were evaluated.The cytokine concentrations in the peripheral blood among the three groups before radiotherapy(T0),at the end of radiotherapy(T1),one month after radiotherapy(T2)and three months after radiotherapy(T3)were measured by ELISA.2 According to Joint Center for Radiation Therapy(JCRT),cosmetic effect of patient breasts among the three groups before radiotherapy(T0),at the end of radiotherapy(T1),one month after radiotherapy(T2)and at three months after radiotherapy(T3)were compared.The Self-rating Anxiety Scale(SAS)was filled in to understand the patient psychological status among the three groups before(T0)and after radiotherapy(T1).To understand the influence of different radiotherapy schemes on patients' cosmetic effect and the change of patients' psychological state.Results In the course of radiotherapy,4 patients were infected with influenza,2patients withdrew from the study,1 patient did not follow the regulations for reexamination.Therefore,a total of 149 patients were included: 50 patients in the simultaneous radiotherapy group,51 patients in the sequential radiotherapy group,and 48 patients in the conventional radiotherapy group.Follow up to February 2020,and the following-up rate was 100%: 1 There was no significant difference in the incidence of acute skin reaction,radiation pneumonitis and leukopenia among the three groups(?~2=0.129,P=0.938;?~2=0.496,P=0.780;?~2=0.132,P=0.717).2 The concentrations of IL-6,IL-10 and IL-12P70 had no interaction in different radiotherapy schemes and detection time(F=0.233,P=0.797;F=0.792,P=0.461;F=0.232,P=0.842).There was no significant difference in the concentrations of IL-6,IL-10 and IL-12P70 among three groups(F=0.200,P=0.819;F=0.411,P=0.792;F=0.334,P=0.716).The influence of time on theconcentrations of IL-6,IL-10 and IL-12P70 was statistically significant(F=14.081,P<0.001;F=5.443,P=0.019;F=18.541,P<0.001).Compared with that before radiotherapy,the concentrations of IL-6 decreased at the end of radiotherapy,and increased at one month and three months after radiotherapy,the difference was statistically significant(P<0.001,<0.001,0.002;P=0.030,<0.001,0.031;P<0.001,<0.001,<0.001).The concentration of IL-10 at the end of radiotherapy and one month after radiotherapy was higher than that before radiotherapy(P=0.098,0.214,0.112;P=0.073,0.415,0.061).Compared with that before radiotherapy,the concentration of IL-10 increased at three months after radiotherapy,the difference was statistically significant(P<0.001,<0.001,0.006).The concentration of IL-12P70 decreased significantly at the end of radiotherapy compared with that before radiotherapy(P<0.001,<0.001,<0.001).The concentration of IL-12P70 increased one month after radiotherapy compared with that before radiotherapy(P=0.293,0.195,0.132),and three months after radiotherapy compared with that before radiotherapy(P<0.001,<0.001,<0.001).3 There were similar cosmetic effect among the three groups,including before radiotherapy,at the end of radiotherapy,one month after radiotherapy and three months after radiotherapy(?~2=0.168,P=0.919;?~2=0.340,P=0.844;?~2=0.340,P=0.844;?~2=0.340,P=0.844).4 The SAS scores of the three groups before and after radiotherapy were higher than that of the Chinese norm(the national cooperation group based on the average results of 1158 normal people),the difference was statistically significant(t=7.242,P<0.001;t=7.493,P<0.001;t=7.815,P<0.001;t=5.623,P<0.001;t=5.898,P<0.001;t=8.442,P<0.001).The D-value of SAS scores of three groups before and after radiotherapy was analyzed by one-way ANOVA,the difference was statistically significant(F=3.638,P=0.029).There was no significant difference in SAS scores among the three groups post radiotherapy and before radiotherapy(t=1.894,P=0.324;t=1.915,P=0.371;t=0.652,P=0.183).Conclusions 1 The incidence of acute side effects and the satisfaction rate of cosmetology effect are similar among the three groups.The incidence of acute side effects in the group of whole breast radiotherapy with simultaneous tumor bed boost is not increased.2 The scheme of whole breast radiotherapy with simultaneous tumor bed boost reduces the number of times of treatment and shortens the time of treatment after breast conserving surgery for early breast cancer.3 Compared with the conventional radiotherapy group and the sequential radiotherapy group,the simultaneous radiotherapy group reduces the psychological burden of patients.Figure7;Table12;Reference 133.