乳腺癌放疗后晚期毒性的分光光度计和超声评估。
Spectrophotometer and ultrasound evaluation of late toxicity following breast-cancer radiotherapy.
机构信息
Department of Radiation Oncology, Emory University School of Medicine, Atlanta, GA, USA.
出版信息
Med Phys. 2011 Oct;38(10):5747-55. doi: 10.1118/1.3633942.
PURPOSE
Radiation-induced normal-tissue toxicities are common, complex, and distressing side effects that affect 90% of patients receiving breast-cancer radiotherapy and 40% of patients post radiotherapy. In this study, the authors investigated the use of spectrophotometry and ultrasound to quantitatively measure radiation-induced skin discoloration and subcutaneous-tissue fibrosis. The study's purpose is to determine whether skin discoloration correlates with the development of fibrosis in breast-cancer radiotherapy.
METHODS
Eighteen breast-cancer patients were enrolled in our initial study. All patients were previously treated with a standard course of radiation, and the median follow-up time was 22 months. The treated and untreated breasts were scanned with a spectrophotometer and an ultrasound. Two spectrophotometer parameters-melanin and erythema indices-were used to quantitatively assess skin discoloration. Two ultrasound parameters-skin thickness and Pearson coefficient of the hypodermis-were used to quantitatively assess severity of fibrosis. These measurements were correlated with clinical assessments (RTOG late morbidity scores).
RESULTS
Significant measurement differences between the treated and contralateral breasts were observed among all patients: 27.3% mean increase in skin thickness (p < 0.001), 34.1% mean decrease in Pearson coefficient (p < 0.001), 27.3% mean increase in melanin (p < 0.001), and 22.6% mean increase in erythema (p < 0.001). All parameters except skin thickness correlated with RTOG scores. A moderate correlation exists between melanin and erythema; however, spectrophotometer parameters do not correlate with ultrasound parameters.
CONCLUSIONS
Spectrophotometry and quantitative ultrasound are objective tools that assess radiation-induced tissue injury. Spectrophotometer parameters did not correlate with those of quantitative ultrasound suggesting that skin discoloration cannot be used as a marker for subcutaneous fibrosis. These tools may prove useful for the reduction of radiation morbidities and improvement of patient quality of life.
目的
辐射诱导的正常组织毒性是常见的、复杂的、令人痛苦的副作用，影响 90%接受乳腺癌放射治疗的患者和 40%放射治疗后的患者。在这项研究中，作者研究了使用分光光度法和超声定量测量辐射诱导的皮肤变色和皮下组织纤维化。本研究的目的是确定皮肤变色是否与乳腺癌放射治疗中纤维化的发展相关。
方法
我们的初始研究纳入了 18 例乳腺癌患者。所有患者均接受标准疗程放疗，中位随访时间为 22 个月。使用分光光度计和超声仪对治疗和未治疗的乳房进行扫描。使用两个分光光度计参数（黑色素和红斑指数）来定量评估皮肤变色。使用两个超声参数（皮肤厚度和皮下组织的 Pearson 系数）来定量评估纤维化的严重程度。这些测量值与临床评估（RTOG 晚期发病率评分）相关。
结果
所有患者的治疗侧和对侧乳房之间均观察到显著的测量差异：皮肤厚度平均增加 27.3%（p<0.001），Pearson 系数平均降低 34.1%（p<0.001），黑色素平均增加 27.3%（p<0.001），红斑平均增加 22.6%（p<0.001）。除皮肤厚度外，所有参数均与 RTOG 评分相关。黑色素和红斑之间存在中度相关性；然而，分光光度计参数与超声参数不相关。
结论
分光光度法和定量超声是评估辐射诱导组织损伤的客观工具。分光光度计参数与定量超声参数不相关，表明皮肤变色不能作为皮下纤维化的标志物。这些工具可能有助于减少放射治疗的发病率和提高患者的生活质量。
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