背景：乳腺癌的术中放疗（IORT）被用作前期增强或加速部分乳腺照射（APBI）。迄今为止,没有关于IORT后血细胞计数变化的描述。我们的分析显示，在IORT±全乳放疗（WBRT）后5年内，乳腺癌患者的血细胞计数变化。
方法：在58例患者（IORT/APBI组）中以APBI的形式给予IORT，在198例患者（IORT/WBRT组）中给予加强。术中使用低能量X射线[INTRABEAM（TM）系统]给予20Gy的中位剂量，另外对整个乳房每部分给予46Gy/2Gy，如果添加了WBRT。术前收集血细胞计数，90天后和随访1-5年。Dunnett的测试用于计算血液计数随时间的变化。此外,血小板与淋巴细胞比率（PLR），计算每个时间点的中性粒细胞与淋巴细胞比率(NLR)和衍生中性粒细胞与淋巴细胞比率(dNLR).
结果：在IORT/WBRT组中观察到红细胞明显减少，血红蛋白,在整个随访期间，血小板和白细胞以及淋巴细胞的增加。在整个随访期间，在IORT/APBI组中，红细胞和血红蛋白显着下降。关于随访期间与术前相比的变化，与无任何相关化疗影响的IORT/APBI组相比,IORT/WBRT组的变化更为显著.关于PLR-，NLR和dNLR值两组患者在该范围内的比率随时间改善。
结论：与IORT/WBRT相比，IORT/APBI似乎对血细胞计数的影响较小。此外，PLR-,随着时间的推移，NLR和dNLR值有所改善，表明总体上对IORT后的结果有积极影响。
BACKGROUND: Intraoperative radiotherapy (IORT) for breast cancer is used as an upfront boost or as accelerated partial breast irradiation (APBI). To date, no description of blood count changes after IORT are available. Our analysis shows blood count changes in breast cancer patients up to 5 years after IORT ± whole breast radiotherapy (WBRT).
METHODS: IORT was given as APBI in 58 patients (IORT/APBI-group) and as a boost in 198 patients (IORT/WBRT-group). A median dose of 20 Gy was given intraoperatively with low energy X-rays [INTRABEAM (TM) System] and additionally 46 Gy/2 Gy per fraction to the whole breast, if WBRT was added. Blood counts were collected preoperatively, after 90 days and through year 1-5 of follow-up. Dunnett\'s tests were used to calculate changes in blood counts over time. Additionally, platelet-to-lymphocyte ratio (PLR), neutrophil-to-lymphocyte ratio (NLR) and derived neutrophil-to-lymphocyte ratio (dNLR) were calculated for each time point.
RESULTS: Significantly decreases in the IORT/WBRT-group were seen for erythrocytes, hemoglobin, platelets and leucocytes and an increase for lymphocytes for the total follow-up period. In the IORT/APBI-group significantly decreases were seen for erythrocytes and hemoglobin for the total follow-up period. Regarding changes during follow-up compared to the preoperative value, much more significant changes were seen in the IORT/WBRT-group compared to IORT/APBI-group without any relevant impact of chemotherapy. Regarding PLR-, NLR- and dNLR-values the rate of patients over the range improved over time in both groups.
CONCLUSIONS: IORT/APBI seems to have a smaller effect on blood counts compared to IORT/WBRT. Furthermore, PLR-, NLR- and dNLR-values improved over time, suggesting a positive effect on outcome after IORT in general.
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