Sector resection with or without postoperative radiotherapy for stage I breast cancer: a randomized trial.
Sector resection with or without postoperative radiotherapy for stage I breast cancer: a randomized trial.
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I 期乳腺癌的扇形切除术联合或不联合术后放疗：一项随机试验。
DOI：
10.1093/jnci/82.23.1851
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发表时间：
1990
期刊：
影响因子：
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通讯作者：
G. Westman
中科院分区：
文献类型：
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作者：
A. Cohen;U. Ljunggvist;L. Bergkvist;L. Johansson;L. Holmberg;H. Adami;T. Jansson;G. Rikner;Å. Rimsten;B. Stenstam;L. Carlsson;T. Jahnberg;I. Underskog;G. Liljegren;G. Westman
在本试验中，381例组织病理学I期浸润性乳腺癌患者接受了局部切除加腋窝清扫的精细控制的扇形切除。然后，我们随机分配187名妇女接受术后放射治疗，乳房平均总剂量为54GY，194名妇女不接受进一步治疗。符合条件的标准是(A)乳房X线片上可见直径小于或等于20 mm的单灶性肿瘤，以及(B)组织病理学检查中腋窝淋巴结阴性。平均随访时间：放疗组为32.9+/-2.2个月，单纯手术组为29.3+/-2.4个月。3年后局部复发率放疗组为2.9%(95%可信区间，0.1%-5.8%)，单纯手术组为7.6%(95%可信区间，3.0%-12.3%)(P=0.06)。两个治疗组在总存活率(P=.49)或无局部或远处复发的存活率(P=.18)方面没有显著差异。我们的结论是，放射治疗挽救了一些患者的局部复发。然而，我们的数据表明，对于没有腋窝淋巴结受累的单发小肿瘤的女性来说，精细的手术技术可能是手术加常规放射治疗的替代方案。
In this trial, 381 women with invasive breast cancer in histopathologic stage I had sector resection with meticulous control for complete excision of local disease plus axillary dissection. We then randomly assigned 187 women to receive postoperative radiotherapy to a total mean dose of 54 Gy to the breast and 194 women to receive no further treatment. Criteria for eligibility were (a) a unifocal tumor 20 mm or less in diameter that was visible on a mammogram and (b) negative axillary lymph nodes on histopathologic examination. The mean follow-up time was 32.9 +/- 2.2 (SD) months in the group of patients treated with radiation and 29.3 +/- 2.4 months in the group treated with surgery alone. The actuarial local recurrence rate after 3 years was 2.9% (95% confidence interval, 0.1%-5.8%) in the group treated with radiation and 7.6% (95% confidence interval, 3.0%-12.3%) in the group treated with surgery alone (P = .06). The two treatment groups did not differ significantly in overall survival (P = .49) or survival free from regional or distant recurrence (P = .18). We conclude that radiation therapy saves some patients from local recurrence. However, our data suggest that, for women with small unifocal tumors without axillary lymph node involvement, a meticulous surgical technique may be an alternative to surgery plus routine radiotherapy.