LUMPECTOMY COMPARED WITH LUMPECTOMY AND RADIATION-THERAPY FOR THE TREATMENT OF INTRADUCTAL BREAST-CANCER
LUMPECTOMY COMPARED WITH LUMPECTOMY AND RADIATION-THERAPY FOR THE TREATMENT OF INTRADUCTAL BREAST-CANCER
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DOI：
10.1056/nejm199306033282201
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发表时间：
1993-06-03
影响因子：
158.5
通讯作者：
KAVANAH, M
中科院分区：
文献类型：
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作者：
FISHER, B;COSTANTINO, J;KAVANAH, M
研究背景与方法。患有导管原位癌的妇女既可以采用乳房肿瘤切除术，也可以采用乳房肿瘤切除术后再进行放射治疗，但联合治疗的益处尚不确定。818名患有导管原位癌的妇女被随机分配接受乳房肿瘤切除术或乳房肿瘤切除术后乳房照射（50 Gy）。足够的组织被切除，切除标本的边缘在组织学上无肿瘤。平均随访时间为43个月（11 ~ 86个月）。该研究的主要终点是无事件生存期，定义为无新发同侧或对侧乳腺癌、区域或远处转移或其他癌症，无癌症以外原因死亡。接受乳房放疗的妇女的5年无事件生存率更高（84.4%，而单独接受乳房肿瘤切除术的妇女为73.8%;P = 0.001）。这种改善是由于第二同侧乳腺癌的发生率降低；其他事件的发生率在两组中是相似的。在391名单独接受乳房肿瘤切除术的女性中，64名（16.4%）发生同侧乳腺癌；32例为非侵入性，其余32例为侵入性。在399名接受乳房肿瘤切除术和乳房照射治疗的妇女中，28名（7.0%）发生同侧乳腺癌，20名（非侵入性），8名（侵入性）。经放疗，同侧乳腺第二癌的五年累积发病率从非侵袭性癌症的10.4%降低到7.5%，侵袭性癌症的10.5%降低到2.9% （P = 0.055和P = 0.055）
Background and Methods. Women with ductal carcinoma in situ have been treated both by lumpectomy and by lumpectomy followed by radiation therapy, but the benefit of combined therapy is uncertain. A group of 818 women with ductal carcinoma in situ were randomly assigned to undergo lumpectomy or lumpectomy followed by breast irradiation (50 Gy). Sufficient tissue was removed that the margins of the resected specimens were histologically tumor-free. The mean duration of follow-up was 43 months (range, 11 to 86). The principal end point of the study was event-free survival, as defined by the presence of no new ipsilateral or contralateral breast cancers, regional or distant metastases, or other cancers and by no deaths from causes other than cancer.Results. Five-year event-free survival was better in the women who received breast irradiation (84.4 percent, vs. 73.8 percent for the women treated by lumpectomy alone; P = 0.001). The improvement was due to a reduction in the occurrence of second ipsilateral breast cancers; the incidence of each of the other events was similar in the two groups. Of 391 women treated by lumpectomy alone, ipsilateral breast cancer developed in 64 (16.4 percent); it was noninvasive in 32 and invasive in the remaining 32. Of 399 women treated with lumpectomy and breast irradiation, ipsilateral breast cancer developed in 28 (7.0 percent) noninvasive in 20 and invasive in 8). The five-year cumulative incidence of second cancers in the ipsilateral breast was reduced by irradiation from 10.4 percent to 7.5 percent for noninvasive cancers and from 10.5 percent to 2.9 percent for invasive cancers (P = 0.055 and P