乳腺癌保乳术后锁上预防照射与上肢水肿发生的关系

目的 分析乳腺癌保乳术后放疗后,上肢淋巴水肿发生率与锁上预防照射的关系及其他相关因素的分析.方法 回顾分析81例保乳术后乳腺癌患者,均采用三维适形(3DCRT)或调强放射治疗(IMRT)技术.锁上放疗25例(30.9%),腋窝淋巴结未清扫5例,前哨活检6例,其余70例均为全腋窝清扫术.术后单纯放疗16例,放疗化疗综合治疗65例.上肢淋巴水肿评估采用电话问卷方法,患者自行比较两侧上肢,根据差异程度记作1～3分.结果 中位随访时间38.7个月.全部患者上肢水肿发生率24.7%,其中1分12例(60%),2分6例(30%),3分2例(10%).锁上放疗者较未放疗者上肢水肿发生率高,分别为40%和19.7%,P＝0.033.5例腋窝淋巴结未清扫者无1例上肢水肿,腋窝前哨活检有2例(25%)上肢水肿,但与清扫术相比差异均未达到统计学意义.体重≥65kg者有增加水肿发生率趋势,P＝0.094.其他因素,年龄、淋巴结清扫数目、体重指数(BMI)、放疗技术、内分泌治疗和是否化疗均未增加上肢水肿发生率.结论 采用3DCRT或IMRT放疗的保乳术后乳腺癌,锁上放疗增加了上肢淋巴水肿发生率,腋窝淋巴结清扫、体重也有增加水肿的趋势.     

早期乳癌保乳术后放射治疗的疗效观察

目的:观察早期乳腺癌保乳术后放射治疗的疗效。方法:对30例Ⅰ～Ⅱ期乳腺癌患者行乳腺病灶局部切除加腋窝淋巴结清扫,术后全乳腺先用6MV-X线双切线半野照射,全乳腺剂量达40Gy～52Gy(平均46Gy),然后,用9MeV或12MeV电子线局部瘤床加量8Gy～20Gy。腋窝淋巴结有转移者,用6MV-X线和12MeV电子线混合加照锁骨上和腋顶淋巴结引流区域,总剂量50Gy。结果:1年生存率为96.7%,3年生存率为90.0%,5年生存率为86.6%,中位生存率为92个月,局部复发率为0(0/30)。乳房美容评价:医生打分满意度优、中的为86.67%(26/30),患者自评满意度优、中的为93.33%(28/30)。结论:早期乳腺癌保乳术后放射治疗可降低局部复发率,减少并发症,乳房美容效果好,但必须严格掌握保乳手术适应证及综合治疗的相关技术。     

早期乳癌保乳术后放射治疗的疗效观察

目的：观察早期乳腺癌保乳术后放射治疗的疗效。方法：对30例Ⅰ～Ⅱ期乳腺癌患者行乳腺病灶局部切除加腋窝淋巴结清扫，术后全乳腺先用6MV—X线双切线半野照射，全乳腺剂量达40Gy～52Gy（平均46Gy），然后，用9MeV或12MeV电子线局部瘤床加量8Gy020Gy。腋窝淋巴结有转移者，用6MV—X线和12MeV电子线混合加照锁骨上和腋顶淋巴结引流区域，总剂量50Gy。结果：1年生存率为96．7％，3年生存率为90．0％，5年生存率为86．6％，中位生存率为92个月，局部复发率为0（0／30）。乳房美容评价：医生打分满意度优、中的为86．67％（26／30），患者自评满意度优、中的为93．33％（28／30）。结论：早期乳腺癌保乳术后放射治疗可降低局部复发率，减少并发症，乳房美容效果好，但必须严格掌握保乳手术适应证及综合治疗的相关技术。     

Current status of conservative surgery and radiotherapy as primary local treatment for early carcinoma of the breast

Summary Since it is now recognized that breast cancer is commonly a systemic disease at presentation, it is clear that local treatment is limited to providing local tumor control, and that effective systemic therapy is required for the eradication of micrometastatic disease. We here review the current status of conservative surgery and radiotherapy in the treatment of early breast cancer. Results from retrospective studies support the view that this combination is highly effective in achieving local control and maintaining good cosmetic results. Results at five and ten years from prospective trials indicate that survival using this approach is comparable to that of mastectomy. Though further follow-up is required, we do not believe that a large survival difference in favor of either approach will emerge.     

Predictors of local recurrence after conservative surgery and whole-breast irradiation

Purpose To identify independent factors associated with increased risk of local recurrence (LR) in patients with breast cancer treated with conservative surgery and radiotherapy with or without systemic therapy.Methods and materials Between January 1997 and December 2001, 969 women were treated at the Radiation Oncology Department in Chieti. We retrospectively analyzed 802 of them who were treated with conservative surgery and whole breast irradiation with or without systemic therapy. Tangential fields delivering 50 Gy to the whole breast were used and a boost was added for a total dose of 60 Gy. χ²-test or Fisher’s exact test were used to identify independent significant factors that are predictive for LR. Kaplan–Meier method was used to calculate the 8-year rates of recurrence according to age, histologic findings, tumor size, number of positive nodes, margin status, receptor status and systemic therapy use: log-rank test was used to compare these curves. Cox proportional hazard model was used to obtain hazard ratios and 95% CI of LR for each covariate.Results Median follow-up time was 63.1 months. LR occurred in 33 (4.1%) of 802 patients. Percentage of LR was greater in <50 year-olds compared with 50–64 year-olds and ≥65 year-olds (9.8% versus 4.1 and 2.0%, respectively). LR was 18.8% in women with a tumor size >3 cm versus 3.5, 4.0, 5.5% in women with a tumor size of 0.1–1, 1.1–2, 2.1–3 cm, respectively. The 8-year LR rate calculated with Kaplan–Meier method was 6.54±1.51. Multivariate Cox regression analysis showed that independent significant factors that are predictive for LR were: age <50, tumor size >3 cm, positive margin or unknown status, and hormonal therapy alone versus chemotherapy or combined therapy.Conclusions Age and tumor size were the most important and statistically significant factors that correlated independently with higher rates of LR. Women <50 years old and with a tumor size >3 cm had a higher risk of LR. Also margin status and systemic therapy could influence LR risk.     

乳腺癌术后辅助放疗研究的进展

放射治疗在乳腺癌综合治疗中发挥着重要的作用.随着乳腺癌临床-病理、肿瘤生物学特性研究的深入,化疗/内分必治疗的规范化应用,对传统乳腺癌术后辅助放疗的指征与方式、方法受到质疑,学者应重新认识.鉴于放射治疗在理念、原则、技术等方面都在不断的变化,放疗要有目标性而不是传统的包括区域淋巴结在内的大野照射,旨在提高肿瘤局部控制率和生存率的同时如何减少或避免放射损伤.为规范乳腺癌术后辅助放疗,本文综述近年来相关的临床研究,提出乳腺癌术后各部位辅助放疗的指征、技术方法及剂量.     

The 10-Year Local Recurrence and Partial Breast Radiotherapy for Early Breast Cancer Treated by Conservative Surgery

C onservative surgery for early breast cancer was proposed by Keynes in 1924 and has been one of the main therapeutic mea- sures. It has been confirmed by abundant literature that the efficacy of conservative surgery plus whole breast radiotherapy is the …     

乳腺癌保乳术后加速部分乳腺照射的研究进展

传统的乳腺癌保乳术后放疗是对全乳腺进行5周-6周的放疗。随着放射治疗技术的发展,加速部分乳腺照射可能会成为另一选择。该文就加速部分乳腺照射在乳腺癌治疗中的研究进展作一综述。     

Late local recurrences in a randomised trial comparing conservative treatment with total mastectomy in early breast cancer patients.

BACKGROUND: A randomised trial was conducted comparing wide lumpectomy and breast irradiation with modified radical mastectomy. As the follow-up was long (mean duration 22 years), we analysed the variation in the effect of treatment over time. PATIENTS AND METHODS: The trial included 179 patients with a breast cancer measuring 相似文献   

早期乳腺癌保乳手术疗效观察

目的：观察早期乳腺癌保留乳房手术的治疗效果.方法：回顾性分析我院1988年12月-2005年12月问收治的早期乳腺癌加例,其中Ⅰ期26例,Ⅱ期14例,观察实施保乳手术治疗疗效.结果：全部病人手术顺利,近期乳房外形保持较好,手术并发症少.术后随访30-120个月,1例局部复发与转移死亡,局部复发率2.5%,无放疗后合并症.结论：早期乳腺癌保乳手术治疗创伤小、疗效确切、能提高生存质量.术前严格掌握手术适应症,术后规范的综合治疗,是取得良好效果的基础.     

Conservative treatment for infiltrating breast cancer: Ten years follow-up experience

Introduction We retrospectively analyze our experience in conservative treatment for infiltrating advanced breast cancer before implementation of selective sentinel node biopsy, specially focusing on characteristics, incidence, treatment and evolution of local-regional recurrences, disease-free survival time, overall survival and patient’s satisfaction. Material and methods From January 1984 to 31^st December 1998, 739 female patients were operated in our institution, diagnosed as having infiltrating breast cancer. One hundred and eighty-eight patients (25.43%) received conservative treatment and they were followed up until December 2003. Results Average age when diagnosed was 50.42 years old (24–87 years). 53.19% of the patients were premenopausal. After a median follow-up of 129 months (60–198 months), 13 women (6.91%) presented local-regional recurrence and the disease-free time was 48.4 months (8–108 months). Global survival rate was 83.5% and disease free survival rate was 80.85%. Conclusions The management of choice for early stage (I and II) infiltrating breast cancer is nowadays conservative, with a low local-regional recurrence rate and survival rate that are comparable to radical mastectomy, according to the literature. It’s a safe and efficient method that let us preserve the breast with a good esthetical result. In selected cases, when a regional recurrence occurs, a second conservative management is possible with a good control of the disease, although the most widely accepted treatment in these cases is total mastectomy.     

Angiosarcoma of the breast after conservation therapy for invasive cancer, the incidence and outcome. An unforeseen sequela

Purpose. In the past 15 years breast conserving therapy (BCT) has become an important treatment option for primary breast cancer. Thirty three angiosarcomas (AS) after BCT have been described in a total of 20 published reports. Limited follow-up data and the lack of information on incidence of AS prompted the authors to review the comprehensive experience in the Netherlands. Methods. Between 1987 and 1995 twenty-one patients with BCT-associated AS were diagnosed in the Netherlands. Follow-up after diagnosis of AS ranged from 6 to 82 months with a median of 24 months. Information on the total number of patients treated with BCT and on the numbers of angiosarcoma in the breast was obtained. Results. The median interval between BCT and AS was 74 months (range: 29–106) and appeared to decrease with higher age. Detection of skin changes followed by incisional biopsy provided the diagnosis. Two year overall (OS) and disease free survivals were 72% (s.e. 10.9) and 35% (s.e. 10.7), respectively. Two year OS after initial complete surgical resection was 86% (s.e. 9.3) compared to 0% after incomplete resection of the AS (P=0.04). The estimated incidence of AS after BCT is 0.16%. Conclusions. BCT-associated AS arises after a relatively short interval. Although the incidence of AS is low, the absolute number of patients at risk is increasing. This calls for vigilance concerning skin changes occurring after BCT. An incisional biopsy provides the only reliable diagnosis. The prognosis appears to be related to the completeness of surgical resection.     

Cosmetic outcome of breast conservative treatment for early stage breast cancer

Purpose To evaluate the cosmetic outcome of breast conservative therapy and to examine the degree of agreement between the patients’ and oncologists’ ratings. We also analyze the influence of several factors on cosmesis. Methods and materials We retrospectively evaluated 145 patients with primary breast cancer treated by local excision and radiotherapy between January 2000 and May 2001. Cosmetic outcome was evaluated by doctors and patients and was scored as excellent, good, fair or poor. Results 73% of patients rated cosmesis as excellent or good while the percentage was 71% when rated by radiation oncologists. The degree of cosmesis concordance evaluated by oncologists and patients was low (kappa=0.3). In our study the variables which significantly influence on the cosmetic outcome were concomitant adjuvant chemotherapy (p=0.04) and radiation therapy boost, either by electron beam or brachytherapy (p=0.013). Conclusion The cosmetic outcome of breast conserving therapy was good. There was a similar rating by the patient and radiation oncologist, but the level of concordance between patients and doctors was low. Factors that significantly influence the cosmesis appear to be concomitant adjuvant chemotherapy and radiation therapy boost.     

Elderly breast cancer patients treated by conservative surgery alone plus adjuvant tamoxifen: fifteen-year results of a prospective study

BACKGROUND: In elderly patients with early breast cancer and a clinically clear axilla, axillary surgery, sentinel lymph node biopsy, and postoperative radiotherapy to the residual breast may not be necessary because of reduced life expectancy, effectiveness of hormone therapy in achieving long-term disease control, and generally favorable biologic behavior of breast cancer in elderly patients. METHODS: The authors followed 354 prospectively recruited women aged > or =70 years who had primary, operable breast cancer and no palpable axillary lymph nodes. All 354 women were treated with conservative surgery and adjuvant tamoxifen and without axillary dissection or postoperative radiotherapy. Women who had resection margins in tumor tissue were excluded. Endpoints were cumulative incidence of axillary disease, cumulative incidence of ipsilateral breast tumor recurrence (IBTR), and breast cancer mortality. RESULTS: After a median follow-up of 15 years (interquartile range, 14-17 years), the crude cumulative incidence was 4.2% (4% in pathologic T1 [pT1] tumors) for axillary disease, 8.3% (7.3% in pT1 tumors) for IBTR, and 17% for breast cancer mortality. Of the 268 patients who died during follow-up, 222 patients (83%) died from causes unrelated to breast cancer. CONCLUSIONS: Elderly patients with early breast cancer and no palpable axillary lymph nodes may be safely treated safety by conservative surgery without axillary dissection and without postoperative radiotherapy, provided that surgical margins are in tumor-free tissue and that hormone therapy is administered. Sentinel lymph node biopsy is also unnecessary because of the low cumulative incidence of axillary disease, and axillary surgery can be reserved for the small proportion of patients who later develop overt axillary disease.     

乳腺癌保乳综合治疗(附108例分析)

背景与目的：保乳手术已逐步成为早期乳腺癌手术治疗的重要方法之一,本文探讨乳腺癌保乳综合治疗的原则与临床应用疗效。方法：108例乳腺癌,0期（TisN0M0）5例,Ⅰ期（T1N0M0）58例,ⅡA期36例（T2N0M017例,T0-1N1M019例）,ⅡB期（T2N1M0）9例,局部保乳切除＋腋窝淋巴结清扫,术后辅以化疗、放疗、内分泌等综合治疗,随访24-144个月,平均随访78月。结果：随访3年以上者80例,5年以上者65例;5年局部复发率3.75%,局部总复发率6.25%;3年生存率96.3%,5年生存率为92.3%;外形满意率81.5%。结论：掌握保乳的手术指征,保证术后的综合治疗,能够使早期乳腺癌患者接受保乳综合治疗取得满意的疗效。     

Avoiding axillary dissection in breast cancer surgery: a randomized trial to assess the role of axillary radiotherapy.

BACKGROUND: The need to dissect axillary nodes in patients with early breast cancer and clinically negative axilla remains controversial. The aim of the study was to assess the role of axillary radiotherapy (RT) in reducing axillary metastases in patients with early breast cancer who did not receive axillary dissection. PATIENTS AND METHODS: From 1995 to 1998, 435 patients over 45 years old with breast cancer up to 1.2 cm and no palpable axillary nodes were randomized 214 to breast conservation without axillary treatment and 221 to breast conservation plus axillary RT. RESULTS: After a median follow-up of 63 months, overt axillary metastases were fewer than expected: three cases in the no axillary treatment group (1.5%) and one in the RT group (0.5%). Expected cases were 43 in the no axillary treatment group and 10 in the RT group. Rates of distant metastases and local failures were low, and 5-year disease free survival was 96.0% (95% confidence interval, 94.1%-97.9%) without significant differences between the two arms. CONCLUSIONS: This study suggests that occult axillary metastases might never become clinically overt and axillary dissection might be avoided in patients with small carcinomas and a clinically negative axilla. Axillary RT seems to protect the patients from axillary recurrence almost completely.     

A randomised factorial trial of sequential doxorubicin and CMF vs CMF and chemotherapy alone vs chemotherapy followed by goserelin plus tamoxifen as adjuvant treatment of node-positive breast cancer

The sequential doxorubicin --> CMF (CMF=cyclophosphamide, methotrexate, fluorouracil) regimen has never been compared to CMF in a randomised trial. The role of adding goserelin and tamoxifen after chemotherapy is unclear. In all, 466 premenopausal node-positive patients were randomised to: (a) CMF x 6 cycles (CMF); (b) doxorubicin x 4 cycles followed by CMF x 6 cycles (A --> CMF); (c) CMF x 6 cycles followed by goserelin plus tamoxifen x 2 years (CMF --> GT); and (d) doxorubicin x 4 cycles followed by CMF x 6 cycles followed by goserelin plus tamoxifen x 2 years (A --> CMF --> GT). The study used a 2 x 2 factorial experimental design to assess: (1) the effect of the chemotherapy regimens (CMF vs A --> CMF or arms a+c vs b+d) and (2) the effect of adding GT after chemotherapy (arms a+b vs c+d). At a median follow-up of 72 months, A --> CMF as compared to CMF significantly improved disease-free survival (DFS) with a multivariate hazard ratio (HR)=0.740 (95% confidence interval (CI): 0.556-0.986; P=0.040) and produced a nonsignificant improvement of overall survival (OS) (HR=0.764; 95% CI: 0.489-1.193). The addition of GT after chemotherapy significantly improved DFS (HR=0.74; 95% CI: 0.555-0.987; P=0.040), with a nonsignificant improvement of OS (HR=0.84; 95% CI: 0.54-1.32). A --> CMF is superior to CMF. Adding GT after chemotherapy is beneficial for premenopausal node-positive patients.     

Lumpectomy with or without postoperative radiotherapy for breast cancer with favourable prognostic features: results of a randomized study

The aim of this trial was to study the value of adding post-operative radiotherapy to lumpectomy in a subgroup of breast cancer patients with favourable patient-, tumour-, and treatment-related prognostic features. 152 women aged over 40 with unifocal breast cancer seen in preoperative mammography were randomly assigned to lumpectomy alone (no-XRT group) or to lumpectomy followed by radiotherapy to the ipsilateral breast (50 Gy given within 5 weeks, XRT group). All cancers were required to be invasive node-negative, smaller than 2 cm in diameter and well or moderately differentiated, to contain no extensive intraductal component, to be progesterone receptor-positive, DNA diploid, have S-phase fraction 相似文献   

Use of modern radiation therapy following surgery for invasive breast cancer

Radiation therapy has long been used in the treatment of breast cancer. However, it is still very difficult to state with certainty whether or not radiation therapy is truly beneficial for patients with breast cancer, mainly because breast cancers are very heterogeneous in their clinical behavior, and because radiation therapy has undergone significant change in the methodology. We extensively reviewed the literature, and determined that radiation therapy increases the survival of some patients, particularly in conjunction with surgery and systemic therapy. Although the total proportion of such patients seems to be small, applied to the general population of breast cancer patients, the absolute number of women who might benefit from radiation therapy may be quite large.     

乳腺癌保留乳房治疗42例报告

目的 :研究乳腺癌保乳手术的近期效果。方法 :对 0期 (导管内癌 )、I期和部分Ⅱ期乳腺癌患者共 90例进行非随机对照研究 ,观察保乳术 ( 4 2例 )和全乳切除术 ( 4 8例 )的近期效果。结果 :保乳术占同期乳腺癌手术的 19% ,保乳术组中位随访2 8个月 ,有 2例局部复发 ( 4 8% ) ,均为 0期乳腺癌 ,年龄均 <40岁 ;全乳切除术组中位随访 3 1个月 ,无局部复发 ,但 1例发生对侧乳腺癌 ( 2 1% ) ;两组均无远处转移及死亡病例。保乳术组美容效果满意率为 92 9%。结论 :保乳术也适于中国乳腺癌患者 ,美容效果满意 ,但存在一定的局部复发率 ,导管内癌局部处理较浸润癌更应慎重。