The effect of treatment interruptions in the postoperative irradiation of breast cancer
The effect of treatment interruptions in the postoperative irradiation of breast cancer
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DOI：
10.1159/000087909
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发表时间：
2005-01-01
期刊：
影响因子：
3.5
通讯作者：
Ober, A
中科院分区：
文献类型：
--
作者：
Bese, NS;Sut, PA;Ober, A
目的：有很多证据表明，治疗中断对肿瘤控制的不利影响，特别是在头颈部癌症中。为了确定乳腺癌术后放疗治疗中断的结果，对1990年至1999年期间接受治疗的853例女性患者进行了回顾性分析。方法：接受新辅助化疗的局部晚期乳腺癌患者未纳入本研究。分析了546例（64%）接受乳房切除术的患者和307例（36%）接受保乳手术的患者。胸壁/乳房和区域淋巴结的总剂量为50戈伊（46-54戈伊），每日1.8- 2-戈伊，每周5次。保乳手术患者瘤床给予14-戈伊（10- 20-戈伊）光子或电子增强。741例（87%）患者发生计划外治疗中断，间隔的中位持续时间为13天（1-91天）。共有348例患者（41%）没有治疗中断或中断1周或更短时间，而505例患者（59%）的治疗中断超过1周。用Kaplan-Meier法估计局部控制率（LC）和总生存率（OS）。使用考克斯比例风险回归模型评估宿主和治疗相关因素对LC和OS的影响（年龄、更年期状态、组织学亚型、分级、激素受体状态、pT分期、pN分期、手术类型、辅助治疗、间隙数量和间隙持续时间）。结果：所有患者5年和10年的LC率分别为95%和87%，5年OS率为78%，10年OS率为62%。无治疗中断或中断1周或更短时间的患者组5年和10年的LC率分别为94%和90%，而中断超过1周的患者组5年和10年的LC率分别为89%和86%（p=0.019）。在影响LC的多变量分析中，治疗中断超过1周和绝经前状态似乎是独立的不良预后因素（分别为p=0.043和p=0.005）。在多变量分析中，未中断治疗或中断1周或更短时间的患者的OS率也显著优于中断治疗超过1周的患者（p=0.026）。结论：乳腺癌术后放疗中断超过1周会对治疗结果产生不利影响。版权所有（C）2005 S. Karger AG，巴塞尔。
Objective: There is much evidence for the detrimental effect of treatment interruptions on tumor control, particularly in head and neck cancer. In order to determine the outcome of the treatment interruptions in postoperative irradiation of breast cancer, 853 female patients treated between 1990 and 1999 inclusive were retrospectively analyzed. Methods: Locally advanced breast cancer patients who received neoadjuvant chemotherapy were not included in the study. Five hundred and forty-six patients (64%) treated with mastectomy and 307 patients (36%) with breast-conserving surgery were analyzed. A total dose of 50 Gy (46-54 Gy) was given to the chest wall/breast and regional lymph nodes in 1.8- to 2-Gy daily fractions, 5 times per week. A 14-Gy (10- to 20-Gy) photon or electron boost was given to the tumor bed of the patients with breast-conserving surgery. Unplanned treatment interruptions occurred in 741 (87%) of the patients and the median duration of the gaps was 13 days (1-91 days). A total of 348 patients (41%) had no treatment break or interruptions of 1 week or less, whereas 505 patients (59%) had treatment interruptions of more than 1 week. The locoregional control (LC) and overall survival (OS) rates were estimated with the Kaplan-Meier method. A Cox proportional hazard regression model was used to evaluate the influence of host- and treatment-related factors on LC and OS (age, menopausal status, histological subtype, grade, hormonal receptor status, pT stage, pN stage, type of surgery, adjuvant treatment, number of gaps and duration of gaps). Results: For all patients LC rates for 5 and 10 years were 95 and 87%, respectively, and OS rates were 78% for 5 years and 62% for 10 years. LC rates for the group of patients with no treatment break or interruptions of 1 week or less, for 5 and 10 years were 94 and 90%, whereas the LC rates for 5 and 10 years were 89 and 86%, for the group of patients with interruptions of more than 1 week (p=0.019). Treatment interruptions of more than 1 week and premenopausal status appeared to be independent adverse prognostic factors in multivariate analyses affecting the LC (p=0.043 and p=0.005, respectively). The OS rates for the patients without treatment interruptions or interruptions of 1 week or less were also significantly better than for the patients with treatment interruptions of more than 1 week (p=0.026) in multivariate analyses. Conclusion: Interruptions more than 1 week during postoperative irradiation of breast cancer adversely affect the treatment outcome. Copyright (C) 2005 S. Karger AG, Basel.