早期乳腺癌保乳治疗的临床研究

目的：探讨早期乳腺癌保乳术后综合治疗的效果。方法：对１０８例早期乳腺癌行保乳治疗，并与同期行改良根治术治疗的１２１例早期乳腺癌行对比研究。保乳治疗患者年龄３１～６１岁，中位年龄４４.５岁。保乳术后行全乳腺放疗和瘤床加量，处方剂量５０Ｇｙ／５周，瘤床追加６～９ＭｅＶ电子线１０～１５Ｇｙ／７～１０天。改良根治术患者年龄３４～６８岁，中位年龄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，处方剂量５０Ｇｙ／５周。两组均采用ＣＡＦ或ＣＭＦ方案化疗，ＥＲ或ＰＲ阳性的患者给予内分泌治疗。结果：１０８例保乳治疗患者中３例复发，５例出现远处转移（２例为骨转移，１例为骨、肝、肺多发转移，２例为肺转移）。术后６个月美容效果评估优、良者为９１.７％，术后１年为９２.６％。１２１例改良根治术患者中３例复发，７例出现远处转移（３例为骨转移，３例为肺转移，１例为多发脏器转移）。两组的近期疗效差异均无统计学意义（Ｐ＞０.０５）。结论：早期乳腺癌采用保乳术及术后综合治疗的疗效不低于改良根治术，且美容效果更优。

Clinical study of conservative and modified radical mastectomy for early breast cancer

Objective：To investigate the effects of breast conserving therapy（BCT） in early breast cancer.Methods：One hundred and eight early stage breast cancer patients underwent BCT plus postoperative radiation（RT）.During the same period,121 similar patients were treated by modified radical mastectomy（MRM） plus RT.All patients were female with median age of 45.5 years（range,31-61 years） of BCT and with median age of 47.6 years（range,34-68 years） of MRM.All patients with BCT underwent postoperative radiotherapy.The entire breast with tangential fields delivered 50Gy with 6MV X-ray beam in 5 weeks.An additional 10-15Gy was delivered in 7-10 days to tumor bed with electron beam.In the 121 MRM ＋ RT patients,the post operative radiotherapy was given as the range of radiation dose 50Gy in 5 weeks depends on the size and involvement of axillary nodes.All patients also received adjuvant chemotherapy with CAF or CMF.Patients with positive ER or PR assay results received tamoxifen.Results：The patients of local recurrence,metastasis and death were 4,6 and 8 in BCT group,versus 3,7 and 10 in the MRM group.No statistical significant differences were found between these of two groups（P〉0.05）.Cosmetic evaluation of breast was carried out post-operatively at points of six months,one year,91.7% and 92.6% of the patients assessed as excellent or fine cosmetic state respectively.Conclusion：Breast conserving therapy for early stage breast cancer can get satisfactory results.However,breast conserving surgery should selectively be used only for early stage breast cancer,and should be combined with postoperative radiotherapy,chemotherapy and hormone therapy in order to guarantee success.