Effectiveness of mastectomy by response to induction chemotherapy for control in inflammatory breast carcinoma
Effectiveness of mastectomy by response to induction chemotherapy for control in inflammatory breast carcinoma
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DOI：
10.1007/bf02303668
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发表时间：
1997-09-01
影响因子：
3.7
通讯作者：
Singletary, SE
中科院分区：
文献类型：
--
作者：
Fleming, RYD;Asmar, L;Singletary, SE
背景：对于炎性乳腺癌（IBC）的最佳局部控制所需的治疗方案存在争议。进行这项研究，以确定是否乳房切除术结合放疗提供了任何优势，单独在IBC的患者谁曾与阿霉素为基础的联合chemotherapy.Methods：178名妇女治疗IBC的阿霉素为基础的多模态治疗协议之间的回顾性分析，1974年1月至1993年9月进行。分析了临床和组织学对治疗的反应、局部复发时间、生存率和局部疾病的最终控制。Kaplan-Meier分析用于检查生存和复发时间，Fisher精确检验用于检验治疗结果的差异。结果：中位随访时间为89个月（范围22 ~ 223个月）。局部疾病持续7名患者和复发的44名患者已呈现疾病免费的中位时间为10个月。局部复发（LR）后的死亡率为98%，除1例LR外，所有患者均发生全身转移。对诱导化疗的反应影响LR的发生率，乳腺切除标本的组织学检查发现的残留病变量是局部失败的高度预后因素。接受乳房切除术加放疗的患者LR的发生率低于仅接受放疗的患者（16.3%对35.7%，p = 0.015）。结论：在联合化疗加放疗的基础上增加乳房切除术可改善IBC患者的局部控制。在化疗加放疗的基础上增加乳房切除术可以提高对诱导化疗有临床完全或部分反应的患者的无远处疾病生存率和总生存率。对诱导化疗无显著反应的患者在治疗方案中加入乳房切除术后，没有获得生存或局部疾病控制方面的益处。这些患者应考虑进入新治疗方案的临床试验。
Background: Controversy exists as to the treatment regimen necessary to best provide optimal local control for inflammatory breast carcinoma (IBC). This study was conducted to determine if mastectomy combined with radiotherapy offered any advantages over radiotherapy alone in patients with IBC who had been treated with doxorubicin-based combination chemotherapy.Methods: A retrospective review of 178 women treated for IBC on doxorubicin-based multimodality therapy protocols between January 1974 and September 1993 was performed. Clinical and histologic response to treatment, time to local recurrence, survival, and ultimate control of local disease were analyzed. Kaplan-Meier analysis was used to examine survival and relapse times, and Fisher's exact test was used to test differences in treatment outcomes. Significance was determined at p less than or equal to 0.05.Results: Median follow-up was 89 months (range 22 to 223 months). Locoregional disease persisted in seven patients and recurred in 44 patients who had been rendered disease free at a median time of 10 months. The mortality rate after a local recurrence (LR) was 98%, and all patients but one with LR developed systemic metastases. Response to induction chemotherapy influenced the incidence of LR, and the amount of residual disease found on histologic examination of mastectomy specimens was highly prognostic for local failure. Patients who underwent mastectomy in addition to radiotherapy had a lower incidence of LR than did patients who received radiotherapy alone (16.3% vs. 35.7%, p = 0.015).Conclusions: The addition of mastectomy to combination chemotherapy plus radiotherapy improved local control in patients with IBC. The addition of mastectomy to chemotherapy plus radiotherapy improved distant disease-free and overall survival in patients with a clinical complete or partial response to induction chemotherapy. Patients who had no significant response to induction chemotherapy received no survival or local disease-control benefit from the addition of mastectomy to their treatment regimen. These patients should be considered for entry into clinical trials of new treatment regimens.