早期乳腺癌保乳手术后10年局部复发与部分乳腺放疗

目的:总结早期乳腺癌保乳手术后局部复发的表现,分析全乳放疗的作用。方法:1990年4月至1995年12月保乳治疗原发性早期乳腺癌49例。行象限切除加腋窝淋巴结清扫术40例,单纯肿块局部广泛切除术9例。术后全乳切线加瘤床放疗39例,全乳切线照射整个乳房,6-MVX线,中平面剂量45GY,瘤床补加电子束剂量15GY。结果:本组10年复发3例,占6.12%(3/49),均为非浸润性癌。术后不加全乳放疗组局部复发率高(2.56%与20.00%)。行象限切除加腋窝淋巴结清扫手术组局部复发率低于单纯肿块局部广泛切除术组(2.5%与22.22%)。局部复发病例100%为原位复发。结论:保乳术后放疗是必要的,只限于肿瘤邻近区域足够剂量的放疗方式应该是可行的。

Local Recurrence and Radiotherapy on Partial Breast 10 Years after Early Breast-Conserving Surgery

Objective: To summarize the expression of local relapse after early breast-conserving surgery and to analyze the role of whole-breast radiotherapy. Methods: From April 1990 to December 1995, 49 cases with early primary breast cancer were treated by breast-conserving surgery among which, 40 cases underwent quadrant-ectomy plus axillary lymph node dissection and the other 9 received lumpectomy alone. After surgical procedure, a whole-breast tangential irradiation plus tumor-bed radiotherapy was conducted in 39 patients with 6 MV X-ray. The dose for midplane of the whole breast was 45GY/22～23f/4.5W, then a 15-GY boost dose was delivered with tumor bed radiotherapy. Results: Recurrence occurred in 3 of the patients of this group within 10 years, all were non-invasive carcinoma, accounting for 6.12% (3/49). The local recurrence rate in the group without whole-breast radiotherapy after operation was higher compared with that in the group of whole-breast tangential irradiation plus tumor-bed radiotherapy (20.00% vs 2.56%). The local recurrence in the group of quadrant-ectomy plus axillary lymph node dissection was lower than that in the group receiving lumpectomy alone (2.5%vs22.22%). Recurrence in all the case were the recurrence in situ. Conclusion: Radiation therapy after breast-conserving surgery is necessary. It should be feasible that radiotherapy with sufficient dose in neighboring area of the tumor should be feasible.