Radiation therapy and survival in breast cancer patients with 10 or more positive axillary lymph nodes treated with mastectomy
Radiation therapy and survival in breast cancer patients with 10 or more positive axillary lymph nodes treated with mastectomy
复制标题
DOI：
10.1200/jco.1998.16.5.1655
复制
发表时间：
1998-05-01
影响因子：
45.3
通讯作者：
Elledge, RM
中科院分区：
文献类型：
--
作者：
Diab, SG;Hilsenbeck, SG;Elledge, RM
目的：对于有10个或更多阳性腋窝淋巴结（ALN）的患者，建议在乳房切除术和辅助全身治疗后经常进行辅助局部区域放射（XRT），以降低在该亚组中观察到的高局部区域失败率。在这项研究中，我们探讨的可能性，辅助局部放射治疗（LR-XRT）也可以减少远端失败，提高总生存率（OS）在这个子集的预后不良patients.Patients和方法：Retroperitoneal，618例乳腺癌患者10个或更多的积极ALN进行了研究。中位随访时间为7.5年。所有患者均接受了全身辅助治疗，35%的患者还接受了辅助放射治疗。采用考克斯回归模型对局部区域失败、远处失败和OS分析进行年龄、肿瘤大小、阳性ALN数量和雌激素受体（88）状态的校正。在5年时，30%的患者首次发生局部区域性失败，54%的患者发生远端失败。辐射显著降低了局部区域故障（危险率比[RR] = 0.29; 95%置信区间[CI]，0.19至0.45）。调整后的5年局部区域失败率为13%，放射治疗和38%，无放射治疗（P = 0.0001）。放射治疗也与远程控制改善相关（RR = 0.75; 95%CI，0.58 - 0.96）。校正后的5年远处转移失败率为48%（放疗组）和58%（非放疗组）（P = 0.02）。放疗也改善了OS（RR = 0.68; 95% CI，0.53 - 0.85）。调整后的5年OS为56%与辐射和42%没有辐射（P = 0.001）。结论：在这个队列的高危乳腺癌患者，XRT与较少的局部区域和远处失败和改善OS。这表明，改善局部区域控制可能会减少继发性全身扩散，提高生存率。(C)1998年，美国临床肿瘤学会。
Purpose: Adjuvant loco-regional radiation (XRT) frequently is recommended after mastectomy and adjuvant systemic therapy in patients with 10 or more positive axillary lymph nodes (ALN) to reduce the high loco-regional failure rate observed in this subset. In this study we explored the possibility that adjuvant locoregional radiation therapy (LR-XRT) also could decrease distant failure and improve overall survival (OS) in this subset of poor-prognosis patients.Patients and Methods: Retrospectively, 618 breast patients with 10 or more positive ALN were studied. The median follow-up time was 7.5 years. All patients received systemic adjuvant therapy and 35% also received adjuvant radiation therapy. Loco-regional failure, distant failure, and OS analyses were adjusted for age, tumor size, number of positive ALN, and estrogen receptor (88) status using Cox regression model.Results: As expected, patients had a very high risk of loco-regional and distant failure. At 5 years, 30% of patients had loco-regional failure as a first event and 54% had distant failure. Radiation dramatically reduced loco-regional failure (hazards rate ratios [RR] = 0.29; 95% confidence interval [CI], 0.19 to 0.45). The adjusted 5-year loco-regional failure rate was 13% with radiation and 38% without radiation (P = .0001). Radiation also was associated with improved distant control (RR = 0.75; 95% CI, 0.58 to 0.96). The adjusted 5-year distant failure rate wets 48% with radiation and 58% without radiation (P = .02). OS also improved with radiation (RR = 0.68; 95% CI, 0.53 to 0.85). The adjusted 5-year OS was 56% with radiation and 42% without radiation (P = .001).Conclusion: In this cohort of high-risk breast cancer patients, XRT was associated with less loco-regional and distant failure and improved OS. This suggests that improved loco-regional control might decrease secondary systemic spread and improve survival. (C) 1998 by American Society of Clinical Oncology.