术后放疗对局部淋巴结阳性行保乳手术的乳腺癌患者临床预后的影响

目的 研究术后放疗对局部淋巴结阳性行保乳手术的乳腺癌患者临床预后的影响.方法 选择行保乳手术治疗并且出现局部淋巴结转移的84例乳腺癌患者,均于保乳手术后进行放疗.观察患者的5年和10年生存率、无瘤生存率、无远处转移生存率、无局部复发生存率;并分析影响预后的因素.结果 患者的5年生存率为97.62%、无远处转移生存率为95.24%、无瘤生存率为94.05%、无局部复发生存率为95.24%;10年生存率为86.90%、无远处转移生存率为85.71%、无瘤生存率为82.14%、无局部复发生存率为85.71%.经过单因素分析发现,有无术后辅助化疗、有无术后放疗以及清扫淋巴结总数均为影响局部复发的危险因素;经过多因素COX回归分析发现,术后放疗是降低局部复发的惟一影响因素.结论 术后放疗有利于改善局部淋巴结阳性行保乳手术的乳腺癌患者的临床预后情况,可以有效提高生存率,降低局部复发率,在保乳术后具有重要作用,值得应用推广.     

乳腺钼靶伴有倾向恶性钙化的乳腺癌患者保乳术后的预后分析

目的:回顾性分析乳腺钼靶伴有倾向恶性钙化以及不同年龄的乳腺癌患者行保乳术后的预后。方法:收集2005年1 月至2008年12月436 例天津医科大学肿瘤医院行保乳术的乳腺癌患者的临床病理资料。根据患者乳腺钼靶中是否伴有倾向恶性钙化分为钙化组（122 例）和对照组（314 例）。 根据年龄大小分为年轻组（年龄≤ 35岁）,中年组（36～55岁）,老年组（年龄> 55岁）3 个亚组。单因素生存分析采用Logrank 法,多因素分析采用Cox 回归模型。结果:乳腺钼靶伴有倾向恶性钙化是保乳患者的局部复发及总生存的独立危险因素。亚组分析显示,年轻患者中钙化组患者发生复发、转移及死亡事件的例数较对照组多;中年患者中钙化组局部无复发生存及总生存均较差,差异具有统计学意义;老年患者中有无倾向恶性钙化不影响患者的局部无复发生存及总生存。结论:乳腺钼靶伴有倾向恶性钙化是乳腺癌患者保乳术的局部复发及总生存的独立危险因素。对于老年患者钼靶伴有倾向恶性钙化不应作为其保乳的禁忌证。      

年龄对保乳术后局部复发风险的影响

目的:探讨与乳腺癌保乳术后局部复发相关的因素。方法:回顾性分析2000年1月—2007年12月接受保乳手术的548例乳腺癌患者的病历资料并进行随访。对与乳腺癌保乳术后局部复发相关的因素进行单因素和多因素分析。结果:548例患者中,局部复发22例(4.01%)。年龄(<45岁和≥45岁,P=0.041)、肿瘤大小(T1、T2和T3,P=0.014)和组织学分级(Ⅰ～Ⅱ级和Ⅲ级,P=0.003)与局部复发相关。多因素分析结果显示,年龄(<45岁和≥45岁,P=0.013)和组织学分级(Ⅰ～Ⅱ级和Ⅲ级,P=0.046)是影响乳腺癌保乳术后局部复发的独立因素。结论:青年乳腺癌患者(<45岁)保乳术后具有相对较高的局部复发风险,临床医师应当采取更为积极的治疗措施以预防局部复发。     

早期乳腺癌患者保乳术联合术后放疗与乳房全切术的疗效对比

目的:探讨早期乳腺癌患者保乳术联合术后放疗与乳房全切术的远期疗效。方法:回顾性分析126例保乳手术联合术后放疗与144例乳房全切术治疗早期乳腺癌患者临床病理资料及随访结果,对比两组患者的5年总生存率（overall survival,OS）、无病生存率（disease-free survival,DFS）,采用单因素及多因素Cox回归分析两组患者临床病理资料对局部区域复发（local regional recurrence,LRR）及总生存的影响因素。结果:所有患者中位随访时间(84.890±20.474)个月,两组患者临床病理资料差异均无统计学意义（P>0.05）。保乳组:5年总生存率97.6%,5年无病生存率96.8%;乳房全切术组:5年总生存率97.2%,5年无病生存率97.2%,两组5年总生存率、无病生存率均无差异（P>0.05）。Cox多因素回归分析显示,HER-2过表达与局部区域复发率［HR:3.036(95%CI:1.084~8.504)］及总生存率［HR:3.767(95%CI:1.115~12.727)］均相关。结论:早期乳腺癌患者保乳术联合放疗与乳房全切术在5年总生存率、无病生存率方面无显著差异（P均>0.05）。HER-2过表达是影响早期乳腺癌局部区域复发率及总生存率的独立危险因素。在未来的治疗过程中,更倾向于选择保乳术联合术后放疗对早期乳腺癌患者进行治疗。     

乳腺癌保守手术治疗后同侧局部复发危险因素的探讨

目的 探讨临床、病理因素及辅助治疗对乳腺癌保守手术合并放疗后同侧局部复发的影响。方法 应用Kaplan-Meier方法和Cox比例风险模型对126例保乳术合并放疗的早期乳腺癌患者进行回顾性分析。结果 多因素条件下56岁以上乳腺癌患者保乳手术合并放疗后同侧局部复发的风险比为2.17,EIC阳性的风险比为3.46,病灶切缘不净为1.68,无辅助TAM治疗组的风险比为1.52。结论 年龄、EIC及切缘情况对保乳术合并放疗后同侧局部复发有重要的影响,同时辅助TAM治疗可以减少局部复发的风险。     

早期乳腺癌规范化保乳治疗的回顾性分析

目的 探讨乳腺癌保乳手术后的疗效及美容效果,研究影响其局部复发的高危因素。方法 选取我院2000年1月-2008年1月同意接受乳腺癌保乳手术的240例病人为研究对象。均为早期乳腺癌、单发肿物、肿物距乳头2cm以上、无患侧乳腺或胸壁放疗史,以及无活动性结缔组织病史。术后给予化疗、放疗及内分泌治疗,并进行长期随访。结果 全组3年和5年的总存活率分别为97.1%、95.8%,全组3年和5年的无病存活率分别为94.2%、90.8%;单因素及多因素分析均表明,切缘远近为影响复发的高危因素。结论 在规范化治疗过程中,要提高乳腺癌的保乳手术疗效,应多注意肿瘤的大小、切缘浸润的情况,以及术后的综合治疗。     

早期乳腺癌部分乳腺加速放疗

随着乳腺癌术后复发模式的研究进展,部分乳腺照射方法 成为乳腺癌放疗的热点.组织间插植、球囊近距离治疗、术中放疗及三维适形放疗和调强放疗等部分乳腺加速放疗已进入临床研究.其局部控制率和安全性与全乳腺照射比较相当,同时具有治疗周期短、方便患者等优势.部分乳腺加速放疗在部分患者有望代替全乳腺放疗,成为早期乳腺癌保乳术后放疗的...     

早期乳腺癌保乳术后三维适形放疗的预后分析

多项试验证实早期乳腺癌保乳术及术后放疗模式与根治术的局部控制率及生存率相似[1-2].笔者回顾性分析2000年1月至2006年12月在本院接受保乳术的84例随访资料完整的早期乳腺癌患者,分析三维适形放疗在保乳治疗中的疗效,以及早期乳腺癌患者保乳术后的预后因素.     

乳腺癌保乳术后三维适形放疗致急性放射性肺损伤的相关因素分析

目的 分析乳腺癌患者保乳术后三维适形放疗致急性放射性肺损伤的危险因素。方法  收集2014年1~12月在本院行乳腺癌保乳术后接受三维适形放疗的86例患者临床资料,采用单因素及多因素logistic回归分析致急性放射性肺损伤的相关因素。结果 急性放射性肺损伤发生率为10.47% （9/86）。单因素分析显示,照射野、患侧肺平均照射剂量及患侧肺V₅、V₁₀、V₁₅ 、V₂₀、V₂₅与急性放射性肺损伤的发生有关（P＜0.05）,多因素logistic回归分析显示V₂₀是影响急性放射性肺损伤的独立危险因素（P＜0.001）。结论 患侧肺V₂₀是乳腺癌患者保乳术后行三维适形放疗致急性放射性肺损伤的独立危险因素。     

乳腺癌保乳术后图像引导放疗技术研究进展

保乳治疗是早期乳腺癌的标准治疗模式。保乳术后全乳照射能有效提高局部控制率和长期生存率。近年来,随着对早期乳腺癌保乳术后复发模式的深入研究,人们认识到保乳术后最常见复发部位为瘤床及其边缘,因此术后加速部分乳腺照射技术在临床上应用越来越广泛,这就对早期乳腺癌保乳术后靶区的准确施照提出了更高要求。利用图像引导放疗(image-guided radiotherapy,IGRT)技术能在线采集患者解剖图像,并与定位图像进行对比,从而发现并纠正治疗过程中的误差,提高放疗施照精度。笔者总结IGRT技术在乳腺癌保乳术后放疗过程中的应用,并对其下一步研究方向进行展望,希望能为更好地开展乳腺癌IGRT技术相关临床研究提供帮助。     

Mammographic density and the risk of breast cancer recurrence after breast‐conserving surgery

BACKGROUND:

Women with invasive breast cancer who are treated with breast‐conserving surgery and radiotherapy face a cumulative risk of local disease recurrence of approximately 10% at 10 years. To the authors' knowledge, the role of mammographic density as a risk factor for the development of local recurrence has not been thoroughly evaluated to date.

METHODS:

Medical records were reviewed for 335 patients who underwent breast‐conserving surgery for invasive breast cancer and for whom a pretreatment mammogram was available. Information was recorded concerning mammographic density as well as tumor features, patient characteristics, and adjuvant treatments received. Patients were categorized for mammographic density based on the Wolfe classification as either low (<25% density), intermediate (25‐50% density), or high (>50% density). A multivariate survival analysis was conducted using the Cox proportional hazards model with local disease recurrence as the primary endpoint.

RESULTS:

Patients in the high mammographic density group experienced a much greater risk of local disease recurrence compared with women with the least dense breasts (10‐year actuarial risks: 21% vs 5%; hazards ratio [HR], 5.7 [95% confidence interval, 1.6‐20; P = .006]). The difference in the rates of disease recurrence at 10 years was pronounced for women who did not receive radiotherapy (40% vs 0% for patients with >50% density and <25% density, respectively; P < .0001).

CONCLUSIONS:

Mammographic breast density is an important risk factor for local breast cancer recurrence among women not receiving breast irradiation. Mammographic density should be taken into consideration when stratifying patients for clinical trials of partial breast radiotherapy. If confirmed, mammographic density might be used to help determine which patients might benefit from radiotherapy. Cancer 2009. © 2009 American Cancer Society.     

It is possible to omit postoperative irradiation in a highly selected group of elderly breast cancer patients

The purpose of this study was the evaluation of the necessity of routinely applied postoperative radiotherapy in a highly selected patient-group after breast conserving surgery. Between 1983 and May 1994, 356 women over 60 years of age with Stage I or II breast cancer were treated by quadrantectomy and axillary dissection followed by either adjuvant irradiation or no radiotherapy. We have analysed our data retrospectively to investigate whether irradiation has any benefit in elderly patients with respect to locoregional recurrence rates. After a median follow-up of 60 months the multivariate model revealed lymph node status (p=0.002) as highly significant with regard to local recurrence free survival. We were not able to identify a positive effect of adjuvant irradiation in patients with negative lymph nodes and positive receptor status: both patient groups with or without irradiation had similar locoregional recurrence rates of 3%. In a subgroup of patients who were lymph node negative, receptor positive, and received adjuvant tamoxifen therapy, the local recurrence rates were as low as 2% in both groups. Concerning these results it may be possible to avoid the morbidity and potential psychological side effects of radiotherapy in breast cancer patients over 60 years of age treated by breast conserving surgery (T1, N0, positive hormone receptor, adjuvant tamoxifen) without increasing risk of locoregional recurrence. These data have to be confirmed in a prospectively randomized fashion.     

Preoperative Core Needle Biopsy does not Increase Local Recurrence Rate in Breast Cancer Patients

Summary Objective. Several case reports and clinical studies in the literature demonstrate needle track seeding after core needle biopsy in patients with breast cancer in up to 50% of cases. The impact of this observation on local recurrence and overall survival rate is, however, not fully investigated. Patients and design. We retrospectively analysed 719 patients after breast conserving surgery and postoperative radiotherapy for stage I and II breast cancer. We divided this group into patients with (189) and without (530) preoperative core needle biopsy. Demographic data, local recurrence and overall survival rate were compared between these two groups. Result. Preoperative core needle biopsy did not significantly influence the local free recurrence rate (median follow-up time of 78 and 71 months, respectively). The prognostic factors and the postoperative therapy did not differ significantly between the two groups. Conclusion. Preoperative core needle biopsy seems to have no detrimental impact on local recurrence and overall survival after breast conserving surgery and postoperative radiotherapy.     

乳腺癌改良根治术术后放疗的疗效及预后影响因素分析

目的 探讨乳腺癌改良根治术术后放疗的疗效及预后影响因素.方法 收集200例乳腺癌改良根治术及术后放疗患者的临床资料,随访3年,统计患者的生存情况、复发情况和远处转移情况,影响乳腺癌改良根治术后放疗患者预后因素采用单因素和Cox风险比例回归模型分析.结果 随访3年,200例患者局部复发或远处转移58例,无病生存142例,...     

前哨淋巴结活检术在早期乳腺癌保乳术中的应用

目的探讨前哨淋巴结活检术（sentinellymph node biopsy,SLNB）在早期乳腺癌保乳术中的应用效果。方法回顾性分析56例pT1.2N0M0期乳腺癌行保乳术＋前哨淋巴结活检术的临床资料。56例SLN阴性,未行腋窝淋巴结清扫术（axillary lymph node dissection,ALND）。术后辅以化疗、放疗,激素受体阳性患者行内分泌治疗。结果56例成功施行保乳手术,保乳术后双乳对称。SLNB替代ALND者各项术后并发症少。中位随访时间36个月（1～72个月）,1例发现局部复发,行乳腺癌改良根治术时发现腋窝淋巴结转移;1例发现腋窝淋巴结复发转移。结论SLNB可以缩小手术范围,减少术后并发症,保留腋窝形态,提高保乳质量。     

Outcome of treatment for ipsilateral breast tumor recurrence in early-stage breast cancer

Introduction: The aims of the study were to assess the outcome among patients with early breast cancer operated on with wide local excision who developed a subsequent ipsilateral breast tumor recurrence, and to identify risk factors for uncontrolled local disease. Uncontrolled local disease (ULD) was defined as the appearance of clinically manifest invasive adenocarcinoma in the remaining breast or on the ipsilateral chest wall which could not be eradicated with salvage treatment during the period of follow-up (2–18 years). Patients and methods: Eighty-five patients in a cohort of 759 patients, treated for invasive Stage I–II breast cancer with breast-conserving surgery 1976–1985 in Stockholm, with a subsequent ipsilateral breast tumor recurrence (IBTR) were reviewed retrospectively. The majority of the patients were premenopausal (58%), node negative (72%), and had received postoperative radiotherapy (79%). Median follow-up time following breast-conserving surgery was 13 (9–19) years. Multivariate Cox's hazard regression was used in the statistical analysis to identify prognostic factors for ULD. Results: The majority (n = 61) of the IBTR's were located in the original tumor quadrant and showed the same histopathological features as the primary tumor. Salvage mastectomy (n = 65) or reexcision (n = 14) were performed in 79 (93%) of the patients. Twenty-one patients developed ULD. Five years following the diagnosis of IBTR the disease-free survival was 59%, the cumulative incidence for ULD was 24%, and for death in breast cancer 34%. In the cohort of 759 patients, patients who received radiotherapy following the primary breast-conserving surgery had 1% cumulative incidence of ULD following the diagnosis of IBTR compared to 4% among patients that received no postoperative radiotherapy. The cumulative incidence at 5 years of ULD following salvage mastectomy was 12% compared to 33% after salvage reexcision. Patients operated on with breast-conserving surgery with an original tumor size < 15 mm, who were treated with salvage mastectomy for IBTR, had in multivariate analysis the lowest relative risk for ULD. Adjuvant chemotherapy following IBTR treatment did not seem to improve local tumor control. Following the diagnosis of IBTR, 78% (n = 21) of the patients with ULD and/or regional recurrence (n = 27), died of a disseminated breast cancer in contrast to 10% (n = 6) among the remaining 58 patients. Conclusion: Uncontrolled local disease is an important outcome measure following breast-conserving surgery. In this cohort, salvage mastectomy provided a superior local control rate compared to salvage reexcision. A higher although not statistically significant rate of ULD was also seen in patients who had not received postoperative radiotherapy as part of their primary treatment.This revised version was published online in October 2005 with corrections to the Cover Date.     

64例乳腺癌保留乳房手术联合术中放射治疗的近期疗效观察

目的观察乳腺癌保留乳房手术应用术中放射治疗后近期疗效、安全性及美容效果等。方法对64例乳腺癌患者行保留乳房手术治疗,并于术中给予放射治疗。观察术后近期疗效、安全性及美容效果等。结果术后随访3～19个月,中位随访10.3个月。64例患者中,1例(1.6%)于1年后局部复发;7例(10.9%)术后发生Ⅰ级放射性肺损伤,10例(15.6%)手术部位局部硬化,8例(12.5%)皮肤颜色改变,8例(12.5%)手术部位疼痛;美容效果方面,达到极好或较好水平共占95.3%(61/64)。结论术中放射治疗在乳腺癌保留乳房手术中的应用可得到满意的近期疗效,且具有较高的临床安全性,同时美容效果良好。     

乳腺癌保乳手术治疗的临床研究

目的：总结保乳手术治疗早期乳腺癌临床经验及观察近期疗效。方法：2000年1月至2006年12月采用肿块局部广泛切除加腋淋巴结清扫或象限切除加腋淋巴结清扫治疗临床单发的、肿瘤直径小于3．0cm、无区域淋巴结转移的女性乳腺癌患者51例，手术切缘距瘤缘2．0cm～3．0cm，术后行辅助放疗、化疗及内分泌治疗。结果：全组随访3～84个月，局部无复发或远处转移。结论：早期乳腺癌病人接受保乳手术治疗可以取得满意的临床和美容效果。     

乳腺癌保乳术后不同放疗方式的疗效及不良反应

目的:回顾性分析早期乳腺癌保乳术后不同放疗方式对局部正常器官的影响,观察不同放疗方式与生存率的关系。方法:收集我院1998-2010年保乳术后接受不同放疗方式治疗的乳腺癌患者121例,其中37例接受常规二维放疗,80例接受三维放射治疗,放疗采用6MV-X线全乳腺放疗50Gy,瘤床电子线外照射加量10Gy或同步加量至60Gy,4例未接受放疗,雌、孕激素受体阳性的患者加用内分泌治疗。治疗结束后每三个月复查至2年,每半年复查至5年,以后每年复查,放射性不良反应按照RTOG评价标准进行评价。结果:全组3年生存率为97.0％,5年生存率为95.0％,5年无瘤生存率为95.0％,局部复发率为0％。二维放疗放射性肺损伤的发生率明显高于三维放疗（P=0.010）。左侧乳腺癌放射性心脏损伤发生率稍高于右侧,但无明显统计学差异（P=0.210）,二维放疗放射性心脏损伤的发生率明显高于三维放疗（P=0.007）。二维放疗引起II°及III°急性放射性皮肤损伤发生率明显高于三维放疗（P=0.003）。美容效果与放射性皮肤反应相关,发生II°及以上皮肤反应的乳腺外观美容效果差于I°及以下皮肤反应的美容效果（P=0.030）。保乳术后接受局部放疗的患者3年生存率为98.0%,5年生存率为98.0%,T1与Ｔ2患者1、3、5年生存率分别为100%与97%、100%与94%、100%与94%,差异具有统计学意义（P=0.014）。结论:保乳术后行局部放疗明显延长生存时间,三维放疗与二维放疗相比5年生存优势未体现,但在保护肺、心脏、皮肤及美容效果方面明显好于二维放疗。