早期乳腺癌保乳手术8例

回顾该院开展的保乳治疗8例,结合实践体会,探讨保乳手术的近期疗效及美容效果。     

老年人早期乳腺癌保乳手术的临床研究

目的探讨保乳手术在老年人早期乳腺癌治疗中的临床应用。方法回顾性分析2002年1月至2007年12月间在克拉玛依市中心医院和新疆医科大学第二附属医院接受保乳手术的46例老年早期乳腺癌患者的临床资料。手术方式为乳腺部分切除加腋窝淋巴清扫,术后辅助放射治疗、化疗和（或）内分泌治疗。结果46例患者手术成功,术后无严重并发症,标本石蜡病理切片显示各切缘均无癌细胞残留,随访9～68个月,2例局部复发,均无远处转移。结论保乳手术创伤小、术后并发症少,是老年人早期乳腺癌安全有效的治疗方法。掌握适应证及禁忌证,以及规范化和个体化治疗是保乳手术成功的关键。     

早期乳腺癌保乳手术治疗的有效性及安全性

目的评价保乳手术治疗早期乳腺癌的有效性及安全性。方法选取2012年1月至2013年1月间收治的92例早期乳腺癌患者为研究对象,采用随机数字表法将其随机分为观察组(48例)和对照组(44例)。观察组患者采用保留乳房的乳腺癌切除术,术后给予辅助放、化疗,激素受体阳性者可配合内分泌治疗。对照组患者采用乳腺癌改良根治术,保留胸大肌和胸小肌,术后辅助化疗或内分泌治疗。比较两组患者术后的生存情况、复发情况及远处转移情况。结果两组患者6个月、2年生存率的差异均无统计学意义(均P>0.05);两组患者术后6个月、2年复发率的差异均无统计学意义(均P>0.05);两组患者术后2年远处转移率(分别为4.2%和4.5%)的差异无统计学意义(P>0.05)。结论保留乳房的乳腺癌切除术在治疗早期乳腺癌时,可最大程度上保留乳房的形体效果、提高患者的生活质量,并保证治疗的安全和有效。     

早期乳腺癌保乳手术56例近期疗效分析

目的探讨早期乳腺癌保乳治疗的近期疗效及美容效果。方法回顾分析56例0～Ⅱ期原发性乳腺癌施行区段、局部扩大切除并腋窝淋巴结清扫，手术后辅以综合治疗的临床资料。结果手术后随访10～48个月，平均随访21个月；患者本人对保留乳房的满意率100％，十分满意者为93％；无局部复发、远处转移和死亡病例。结论0～Ⅱ期乳腺癌实施保乳治疗，近期疗效、美容效果满意，远期效果有待长期随访观察。     

肿瘤整形外科技术应用于早期乳腺癌保乳手术的临床分析

目的：探讨肿瘤整形技术应用于早期乳腺癌保乳术的近期疗效和美容效果。方法回顾性分析25例应用周围腺体组织瓣转位修复法或背阔肌肌皮瓣转位修复法行保乳术（观察组）和25例行传统保乳手术（对照组）患者的临床资料,比较两组患者的手术切除范围、切缘情况、RTOG美容等级评价、术后并发症及复发转移情况。结果观察组中21例行周围腺体组织瓣转位修复,4例行背阔肌皮瓣转位修复,切除乳腺体积为26～1105 cm3,中位体积343 cm3;对照组切除乳腺体积为15~504 cm3,中位体积262 cm3。术中冰冻病理示切缘阳性者观察组有3例,对照组5例,差异无统计学意义（χ2=0.504,P=0.478）。观察组和对照组美容等级评定为优或良的分别为22例（88%）和20例（80%）,两组差异无统计学意义（χ2=0.611,P=0.737）。随访持续时间为2～12个月,中位随访时间为5个月,观察组中1例患者术后2个月出现多发骨转移,所有患者均未出现局部复发,无死亡病例。结论应用整形外科技术行保乳手术治疗早期乳腺癌在达到切缘无瘤累及的基础上,可获得更好的美容效果,且短期临床效果满意,值得进一步临床推广。     

乳腺癌保乳手术原发灶切缘的评估

总结近20年来乳腺癌保乳手术原发灶切缘评估处理的主要临床证据,并详细介绍了评估方法。     

乳腺癌保乳手术后的放射治疗

早期乳腺癌保留乳腺手术后的放射治疗,是欧美国家治疗早期乳腺癌的主要方法之一。本文综述了这种方法近10年来在照射方法、应用技术、与化疗结合适应证等方面的进展。     

保乳手术与改良根治术治疗早期乳腺癌的临床效果

目的观察保乳手术与改良根治术治疗早期乳腺癌的临床效果。方法选取2009年2月至2011年9月间收治的早期乳腺癌且接受手术治疗的128例患者,其中保乳手术治疗56例(保乳手术组),改良根治术72例(改良根治术组),对两组患者的手术时间、出血量、切口长度和住院时间、术后乳房美容效果进行比较,对患者进行门诊随访3年后,比较两组患者术后3年的随访结果,包括生存率、并发症率、腋淋巴结复发及远处转移。结果保乳手术组患者的手术时间及住院时间均短于改良根治术组,保乳手术组的出血量少于改良根治术组,切口长度小于改良根治术组,差异均有统计学意义(P<0.05)。两组患者的术后美容优良率、生存率、并发症发生率、局部复发率、腋淋巴结复发率及远处转移率的差异均无统计学意义(P>0.05)。结论保乳手术与改良根治术治疗早期乳腺癌的远期效果相当,然而保乳手术较改良根治术的手术时间及住院时间更短、切口长度更小、术中出血量更少。     

保乳手术与改良根治术治疗早期乳腺癌的对照研究

<正>乳腺癌是最常见的女性恶性肿瘤,也可发生于男性。目前,手术治疗为首选的治疗方案,乳腺癌根治术是临床最常用的术式。但是,由于根治术存在切除范围大、手术并发症较多、对患者心理影响严重等问题,亟需改进[1-2]。我们采用保乳手术治疗早期乳腺癌患者29例,取得满意效果,现报告     

早期乳腺癌保乳术后全乳放疗替代模式

全乳房照射已被用于降低早期乳腺癌保乳术后同侧乳腺肿瘤复发的风险,并且多项随机临床试验和荟萃分析已经证明这一放疗模式安全有效,但随着放疗技术的进步以及患者生存期的延长,这种标准治疗模式目前也面临着一些挑战,其替代模式受到了越来越多的关注.其中部分乳腺照射、全乳大分割放疗、省略放疗针对不同的乳腺癌患者,疗效与全乳腺常规照射相当,且降低了不良反应,同时缩短了治疗时程,减轻了患者负担,值得在临床推广应用.     

早期三阴乳腺癌患者保乳治疗的预后分析

[目的]探讨Ⅰ～Ⅱ期三阴乳腺癌患者保乳治疗后的预后情况.[方法]回顾性分析吉林省肿瘤医院从2000年1月至2008年9月间行保乳治疗(保乳手术+术后放疗)的临床及随访资料齐全的282例早期乳腺癌患者的临床资料.按其受体表达情况分为ER、PR和Her-2均为阴性的三阴乳腺癌组(47例);其余定义为非三阴乳腺癌组.所有患者随访至2011年9月,分析早期三阴乳腺癌患者的临床特征、局部复发及生存情况.[结果]全组282例乳腺癌患者中29例(10.2％)局部复发,38例(13.5％)远处转移,26例(9.2％)死亡.三阴乳腺癌组与非三阴乳腺癌组的5年局部复发率分别为8.9％和8.5％,两者无明显统计学差异(P=0.167).但两者远处转移率分别为11.6％和9.3％,三阴乳腺癌组明显较高,具有统计学差异(P=0.001).生存分析显示:三阴乳腺癌组的5年总生存率(OS)为96.3％,与非三阴乳腺癌组的92.9％比较无统计学差异(P=0.611).三阴乳腺癌组的5年无病生存率(DFS)为80.0％,而非三阴乳腺癌组为88.1％,两者具有统计学差异(P＜0.001).[结论]早期三阴乳腺癌患者保乳治疗后总生存率、局部复发率与非三阴乳腺癌患者无差异,但远处转移率较高,需要开展更进一步的临床随机对照研究.     

早期乳腺癌保乳手术与改良根治术的临床对比研究

[目的]探讨早期乳腺癌保乳手术的可行性和安全性。[方法]回顾性分析2001年1月～2007年12月期间所行保乳手术38例和改良根治组患者76例。[结果]保乳手术组在手术时间、术中出血量、术后引流总量、术后引流时间。距切缘3cm内的皮瓣缺血情况方面明显优于改良根治组（P〈0．05）,两组在清扫淋巴结数目、患侧上肢水肿发生率、总生存率、总局部复发率和总远处转移率方面无显著性差异（P〉0．05）。[结论]早期乳腺癌保乳手术加术后的综合治疗能取得与改良根治术相同的疗效,而且手术创伤小,术后恢复快．术后并发症少．增加了美容效果,提高了生存质量。     

早期乳腺癌患者行乳腺癌根治术和保乳术后放疗的生存比较

目的 探讨乳腺癌根治术和保乳术后放疗对早期乳腺癌患者生存情况的影响.方法 选择早期乳腺癌379例,分为根治术组(341例)和保乳术后放疗组(38例).分别观察两组患者的Karnofsky评分和复发情况.结果 随访5年时保乳术后放疗组患者Karnofsky评分显著高于根治术组(P＜0.05);保乳术后放疗组患者1、3、5...     

保留乳房手术治疗老年乳腺癌112例

目的:分析老年乳腺癌保留乳房手术治疗的临床效果及预后,进而探讨腋淋巴结清扫术在老年乳腺癌中的意义.方法:对1986年12月～2006年12月在天津医科大学附属肿瘤医院行保留乳房手术治疗的112例乳腺癌患者的临床病理资料进行分析.患者年龄均≥60岁,均接受乳腺癌局部广泛切除术,其中59例同时行腋窝淋巴结清扫术,即保乳手术.结果:51.8%(58/112)的患者合并其它疾病.行腋窝淋巴结清扫术的,临床N.期患者中,30.6%(15/49)的患者累及腋窝,仅2.0%(1/49)的患者淋巴结转移数＞3枚.中位随访31个月(7～288个月),保乳手术组与局部广泛切除术组5年累积生存率分别为84.0%和82.8%(P=0.703);10年累积生存率分别为70.9%和55.0%(P=0.382),差异均无统计学意义.其中临床触诊腋淋巴结阴性患者中49例行保乳手术,36例行局部广泛切除术.术后5年累积生存率分别为84.7%和84.9%(P＝0.795),差异亦无统计学意义.保乳手术组与局部广泛切除术组5年复发率分别为3.7%和8.2%(P=0.258).结论:保留乳房手术术后并发症少,恢复快,适用于老年乳腺癌患者.腋淋巴结清扫并未明显增加老年乳腺癌尤其是,临床触诊腋淋巴结阴性患者的生存率.     

The Influence of Histologic Grade on Outcomes of Elderly Women With Early Stage Breast Cancer Treated With Breast Conserving Surgery With or Without Radiotherapy

BackgroundTwo large randomized trials, CALGB 9343 and PRIME II, support omission of radiotherapy after breast conserving surgery (BCS) in elderly women with favorable-risk early stage breast cancer intending to take endocrine therapy. However, patients with grade 3 histology were underrepresented on these trials. We hypothesized that high-grade disease may be unsuitable for treatment de-escalation and report the oncologic outcomes for elderly women with favorable early stage breast cancer treated with BCS with or without radiotherapy.Materials and MethodsThe Surveillance, Epidemiology, and End Results database was queried for women between 70 and 79 years of age with invasive ductal carcinoma diagnosed between 1998 and 2007. This cohort was narrowed to women with T1mic-T1c, N0, estrogen receptor-positive, invasive ductal carcinoma treated with BCS with or without external beam radiation (EBRT). The primary endpoints were 5- and 10-year cause-specific survival (CSS). Univariate and multivariate analyses were performed. Propensity-score matching of T-stage, year of diagnosis, and age was utilized to reduce selection bias while comparing treatment arms within the grade 3 subgroup.ResultsA total of 12,036 women met inclusion criteria, and the median follow-up was 9.4 years. EBRT was omitted in 22% of patients, including 21% with grade 3 disease. Patients in the EBRT cohort were slightly younger (median, 74 vs. 75 years; P < .01) and had fewer T1a tumors (11% vs. 13%; P = .02). Histologic grades 1, 2, and 3 comprised 36%, 50%, and 14% of the cohort, respectively, and there were no differences in EBRT utilization by grade. Utilization of EBRT decreased following the publication of the CALGB trial in 2004 decreasing from 82% to 85% in 1998 to 2000 to 73% to 75% in 2005 to 2007 (P < .01). Unadjusted outcomes showed that in grade 1 disease, there were no differences in CSS with or without EBRT at 5 (99%) and 10 years (95%-96%). EBRT was associated with an improvement in CSS in grade 2 histology at 5 years (97% vs. 98%) and 10 years (92% vs. 95%) (P = .004). The benefit was more pronounced in grade 3 disease with CSS increasing from 93% to 96% at 5 years and from 87% to 92% at 10 years (P = .02) with EBRT. In the grade 3 subgroup, propensity-score matching confirmed EBRT was associated with superior CSS compared with surgery alone (hazard ratio, 0.58; 95% confidence interval, 0.34-0.98; P = .043).ConclusionIn this database analysis, omission of radiotherapy after BCS in elderly women with favorable-risk, early stage, grade 3 breast cancer was associated with inferior CSS. Further prospective data in this patient population are needed to confirm our findings and conclusions.     

0～Ⅱ期乳腺癌外科保守治疗的疗效观察

目的：探讨早期乳腺癌保守性外科治疗的效果。方法：我院1990年6月－2000年4月对临床早期癌125例行乳房象限切除术加淋巴结清扫术，其中0期3例，I期89例，Ⅱ期33例。全组患者术后乳房放疗102例，未放疗23例。浸润性癌围手术期化疗7周。腋淋巴结阳性术后常规放疗，此后6－12个月内追加12－16次化疗。ER阳性服用TAM 2－5年。此外，选用同期0、I、Ⅱ期仿根治术或根治术常规综合治疗95例做对照观察。结果：1）病理检查：125个象限切除标本中断端阳性10例（8．0％），均以管内癌形式出现。腋淋巴结平均检出16．8枚，阳性率15．2％；2）生存情况：125例随诊，＞3年85例，＞5年63例，全部生存。仅1例术后2．5年局部复发，1例术后2年骨转移带瘤生存；随诊＜3年40例，1例术后1年肺转移带瘤生存；对照组95例，1例肺转移死亡。结论：早期乳腺癌保守性外科治疗与仿根治术，根治术效果相似且能保持乳房良好外形，是I、Ⅱ期乳腺癌理想的治疗方法。     

Applicability of Oncoplastic Breast Conserving Surgery in Asian Breast Cancer Patients

Background: There are limited studies on oncoplastic breast conserving surgery in Asian women. We aimed to determine the applicability and safety of oncoplastic surgery, highlighting the specific circumstances when it will be most useful and compare our preferred technique with the worldwide practice of oncoplastic approaches. Materials and Methods: Breast cancer patients who underwent oncoplastic breast conserving surgery at a single institution from 1st May 201431st March 2015 were included. Data on patient demographics, tumor characteristics and the type of oncoplastic surgery performed were collected. Results: Nineteen breast cancer patients were identified. 42.1% of patients had grade I ptosis. The indications for surgery included a large tumor to breast size ratio (52.6%), multifocal/multicentric lesions (36.8%) and asymmetric breasts (10.6%), averting a mastectomy in 89.4%. Round block was the commonest technique in 63% of patients, in contrast to the inverted T pattern most frequently used in renowned institutions in the West. Mean and median tumor size and weight of specimen were 29.4/25mm (11 75mm) and 77g/64g (10 246g) respectively. Reexcision rate was 10.5%. Complete mastectomy was performed for one patient. One patient developed wound dehiscence which was treated conservatively. Cosmetic outcome was rated as excellent/good by 94.7% of patients. The patients remained clinically well after a median 16 months follow up. Conclusions: Oncoplastic breast conserving surgery is useful in a specific subgroup of Asian patients with a relatively small breast volume and minimal ptosis. Round block was the commonest technique in our series, in contrast to the worldwide utility of oncoplastic techniques. It is oncologically safe and has good cosmetic outcomes.     

Comparision of Different Radiotherapy Planning Techniques for Breast Cancer after Breast Conserving Surgery

Objectives:To compare different radiotherapy planning techniques for breast cancer after breast conserving surgery.Materials and methods: Eighteen patients with breast cancer who underwent breast conserving surgery were selected.For each patient four different whole breast irradiation techniques including Tan, fIMRT, iIMRT and VMAT werecompared to the conventional tangential technique (Tan). Results: Mean maximum point dose (Dmax) for Tan, fIMRT,iIMRT and VMAT were 110.17% (±1.87), 105.89% (±1.13), 106.47% (±0.92) and 106.99% (±1.16) (p<0.001). Meanminimum point dose (Dmin) from Tan was 84.02% (±3.68) which was significantly higher than those from fIMRT,iIMRT and VMAT which were 76.57% (±11.4), 67.69 %( ±19.20) and 80.69% (±7.06) (p<0.001). Only the meanV95 of fIMRT was significantly less than Tan (p=0.01). Mean percentage of volume receiving ≥ 20 Gy (V20Gy) andmean doses of the ipsilateral lung were 17.09% and 953.05 cGy, 16.60% and 879.20 cGy, 14.79% and 772.26 cGy,15.32% and 984.34 cGy for Tan, fIMRT, iIMRT and VMAT. Only iIMRT had a significantly lower mean V20Gy andthe mean dose to ipsilateral lung in comparison with Tan. Significantly, high mean doses to the contralateral breast(498.07 cGy, p<0.001) were observed in VMAT. Conclusion: The conventional tangential technique provides adequatedose coverage but resulted in high dose-volumes. The iIMRT and fIMRT had significantly smaller high dose-volumesand better conformity. VMAT demonstrated excellent dose homogeneity and conformity but an increased low-dosevolume outside the target should be of concern.     

早期乳腺癌保乳术后加速部分乳腺放疗的Meta分析

[目的]评价早期乳腺癌保乳术后加速部分乳腺放射治疗（APBI）的疗效。[方法]计算机检索PubMed、CochraneLibrary、SCI、EMBASE、中文科技期刊全文数据库、中国期刊全文数据库、数字化期刊全文数据库和中国生物医学文献数据库,并辅手工检索和其他检索。纳入比较早期乳腺癌保乳术后APBI与全乳腺放疗（WBRT）的临床对照试验,根据Cochrane系统评价手册5.0.0质量评价标准进行质量评价,使用RevMan5.0软件进行Meta分析。[结果]共纳入4个研究（919例患者）。Meta分析显示：与WBRT相比,APBI后10年总生存率有差异（OR=0.56,95%CI：0.35～0.91）,而5、8年总生存率方面无差异（OR=1.76,95%CI：0.67～4.62;OR=0.86,95%CI：0.44～1.66）;在5、7年绝对美容满意率方面有差异（OR=2.09,95%CI：1.21～3.62,P=0.009;OR=3.42,95%CI：1.25～9.38,P=0.02）,两者5年无复发生存率,肿瘤专项生存率、5年无病生存率,局部复发率、对侧乳腺癌发生率、远处转移率方面均无差异。[结论]APBI是一种可行的早期乳腺癌治疗方式,其明显缩短了疗程,美容效果较好,提高了患者的生活质量。