243例早期乳腺癌保乳治疗的效果分析

目的: 分析总结早期乳腺癌保留乳房综合治疗的效果,观察5年无瘤生存率、总生存率和美容效果。 方法: 选择符合保留乳房标准的早期乳腺癌患者243例,实施保留乳房的局部广泛肿瘤切除手术及腋窝Ⅰ、Ⅱ水平淋巴结清扫或腋窝前哨淋巴结活检,对术中病理报告标本切缘阳性者实施再切除检验,保证切缘阴性后乳腺切除残腔放置银夹标记切除范围和深度。根据术后病理报告确定个体化的综合治疗。根据临床分期需要化疗患者常规行术后辅助全身化疗6个周期;常规放射治疗于术后或化疗2～3个周期后开始,患侧乳房放射剂量50Gy,瘤床部位根据肿瘤大小、所在部位和肿瘤标本切缘状况电子线补充照射10～20Gy。腋窝淋巴结有转移者预防性照射患侧锁骨上淋巴区域50Gy。放疗结束后继续化疗,化疗结束后开始三苯氧胺内分泌治疗5年。定期随访患者局部和全身情况。生命表法计算5年无瘤生存率和总生存率;按Harris标准评估美容效果;按RTOG标准评估急性和晚期放射性损伤。 结果: 243例早期乳腺癌符合保留乳房治疗标准,实施了保乳治疗并且能够接受定期随访,随访中位时间56个月(12～84个月)。7例患者出现局部区域复发;2例患者非肿瘤猝死。5年无瘤生存率93%,5年总生存率98%。美容效果及患者满意度均超过94%。所有患者均未出现严重的急性和晚期放射性损伤。 结论: 符合保乳治疗标准的早期乳腺癌施行保留乳房的综合治疗是可行的,绝大多数患者可以获得满意的美容效果,提高了早期乳腺癌患者的生存质量。

The Effect of Breast Conservation Therapy on Early-stage Breast Cancer

Objective : To analyze and summarize the effect of breast conservation therapy on early-stage breastcancer and to observe the 5-year disease-free survival rate, 5-year overall survival rate and cosmetic resultsof patients who underwent breast conservation therapy. Methods : Lumpectomy with level Ⅰ and Ⅱ axillarylymph node dissection or sentinel lymph node biopsy was performed on eligible early-stage breast cancerpatients. Re-excisions were performed if intraoperative pathological examination indicated positive margins.After the surgical margins were negative, surgical clips were placed in the excision cavity to mark the tumorbed. An individualized comprehensive therapy was provided according to postoperative pathologicexamination. If necessary, six cycles of adjuvant chemotherapy were offered after breast conservationsurgery. Conventional radiotherapy at a total dose of 50 Gy/25f/5w to the whole breast was performed afterthe surgery or after 2-3 cycles of chemotherapy. According to the tumor size, location and surgical marginstatus, the tumor bed was boosted 10-20Gy by electronic beams. Preventive supraclavicular lymph nodeirradiation was performed at a dose of 50Gy if axillary lymph node metastases had been detected.Chemotherapy was continued after radiotherapy. Tamoxifen (20mg/day) was used for 5 years afterchemotherapy. Patients were followed up regularly to observe local and general conditions. The 5-yeardisease-free survival rate and overall survival rate were calculated by Life-Table method. Cosmetic resultswere evaluated by Harris standard. Acute and late toxic effects of radiation were evaluated by RTOGstandard. Results : A total of 243 eligible early-stage breast cancer patients received breast conservationtherapy and were followed up regularly. The median follow-up period was 56 months (12-84 months). Localbreast cancer recurrence was found in 7 patients. Sudden death occurred in 2 patients due to non-cancerousreasons. The 5-year disease-free survival rate was 93% and the 5-year overall survival rate was 98%. Over94% of the patients were satisfied with the therapy. None of the patients had severe acute or late radiationtoxicity. Conclusion : The results of breast conservation therapy for eligible early-stage breast cancer patients are satisfactory. Most of the patients have obtained satisfactory cosmetic results and a good quality of life.