早期乳腺癌保乳治疗的临床研究分析

目的通过早期乳腺癌保乳治疗和改良根治术的比较,探讨早期乳腺癌保乳治疗后的疗效、美容效果和心理变化等问题。方法对68例早期乳腺癌行保乳治疗(本院手术和放化疗59例,外院手术本院放化疗的9例),并与同期行改良根治术治疗的76例早期乳腺癌行对比研究。保乳治疗的全部病例均为女性,年龄范围为28—62岁,平均年龄44．5岁。按全国乳腺癌协作组标准选择病例。保乳术后常规行全乳腺放疗和瘤床加量。改良根治术患者年龄25—68岁,平均47．6岁。改良根治术后放疗的范围根据肿块大小和淋巴结转移情况决定。采用CAF方案化疗。ER／PR阳性的患者均给予口服三苯氧胺内分泌治疗。对68例保乳治疗和76例改良根治术患者的心理变化、性生活和婚姻稳定情况也进行了通信或问讯调查。结果68例保乳治疗患者无局部复发病例,3例出现远处转移(1例为骨转移,1例为骨、肝、肺多发转移,1例为肺、肝转移)。美容效果良好者91．2％,一般者5．6％,差者2．9％。76例改良根治术病例无局部复发,4例出现远处转移(2例为骨转移,1例为脑转移,1例为多发脏器转移)。两个组的近期疗效差异无统计学意义(XP=0．813)。结论早期乳腺癌保乳治疗的疗效与改良根治术基本相同,美容效果和心理的恢复优于改良根治术,是一种值得推广的治疗方法。

Results of a clinical trial comparing conservative and modified radical mastectomy for early breast cancer

Objective The influence of conservative mastectomy plus postoperative radiation(CM+RT) in local control, distant failure, cosmetic and psychological outcome for early stage breast cancer was evaluated comparing with modified radi cal mastectomy. Methods Between January 1998 and December 2003, 68 early stage b reast cancer patients underwent CM+RT. During the save period,76 similar patient s were treated by modified radical mastectomy(MRM+RT). The cosmetic results eval uated as "excellent" , "fair" or "poor" using specific guide lines together with t heir psychological changes. sex life and marital stability were also recorded. A ll patients were female with median age of 44.5 years (range, 28-62 years). Gui d elines for patient selection reported by National Breast Cancer Cooperative Grou p was adhered to. In general, CM consisted of wide local excision with the breas t conserved and postoperative radiotherapy to the entire breast with tangential fields followed by a boost to the tumor bed. All patients also received adjuvant chemotherapy with CAF. Patients with positive ER or PR assay results received t amoxifen for 5 years. In the 76 MRM+RT patients, the post operative radiotherapy and chemotherapy were given as clinically indicated. Results There was no fail ure locally in all.In CM+RT group, the cause of failure was bone metastasis in 1 and mutiple metastases in 2. In the MRM+RT group, the cause of failure was bone metastasis in 2, brain metastasis in 1 and mutiple metastases in 1. The cosmeti c scores were 91.2% excellent, 5.6% fair and 2.9% poor. Conc lusions Breast pres ervation by conservative mastectomy is preferable to mastectomy in appropriately selected patients as it provides equivalent survival but giving good cosmetic r esults.