Breast conservation: long-term results from Westmead Hospital.
Breast conservation: long-term results from Westmead Hospital.
复制标题
乳房保护：Westmead 医院的长期结果。
DOI：
10.1111/j.1445-2197.1997.tb01979.x
复制
发表时间：
1997
期刊：
影响因子：
--
通讯作者：
J. Boyages
中科院分区：
文献类型：
--
作者：
Y. Zissiadis;A. Langlands;B. Barraclough;J. Boyages
背景
保乳术已被证明是一种安全有效的替代乳房切除术在早期乳腺癌。本研究综述了早期乳腺癌保守手术和放射治疗后的长期结果和毒性反应。
方法
1979年11月至1989年12月，438例国际抗癌联盟（UICC）I期或II期乳腺癌患者在Westmead医院接受保守手术和放射治疗（CS+RT）。乳房手术从局部切除术到象限切除术不等，取决于转诊外科医生的偏好。299名患者（68%）进行了腋窝手术解剖。所有患者均接受术后乳房照射。使用6 Mev光子照射整个乳房至46-54戈伊（中位剂量，50戈伊），持续5-6.5周。在336名患者（78%）的原发肿瘤部位给予了加强治疗，通过电子疗法（88名患者），铱-192（247名患者）或光子（1名患者）。共有44例患者（10%）接受了辅助化疗。
结果
存活患者的中位随访期为84个月（范围：56-172个月）。5年局部复发率为6%（312例患者存在风险），10年复发率为10%（52例患者存在风险）。非常年轻的患者（诊断时年龄为34岁）的5年局部复发率为13%，而老年患者为5%（P = 0.04）。无论是原发部位的总剂量还是加强技术都不会影响局部复发。5年无远处复发率为83%。副作用包括肋骨骨折（2%）、症状性肺炎（3%）、需要手术的脂肪坏死或纤维化（4%）和手臂中重度水肿（7%）。
结论
长期数据显示，UICC I期或II期乳腺癌的CS+RT导致局部复发率较低，这受诊断时年龄的影响，但不受辐射剂量或加强技术的影响。这些结果证实了其他国际系列研究的结果，即对于大多数可手术乳腺癌患者，CS+RT是乳房切除术的安全替代方案。
BACKGROUND
Breast conservation has been shown to be a safe and effective alternative to mastectomy in early-stage breast cancer. The present study reviews the long-term outcome and toxicity after treatment of early breast cancer by conservative surgery and radiation.
METHODS
Between November 1979 and December 1989, 438 patients with Union Internationale Contre le Cancer (UICC) stage I or II breast cancer were treated with conservative surgery and radiation therapy (CS+RT) at Westmead Hospital. Surgery to the breast varied from a local excision to a quadrantectomy, depending on the preference of the referring surgeon. The axilla was surgically dissected in 299 patients (68%). All patients received postoperative breast irradiation. The whole breast was irradiated to 46-54 Gy (median dose, 50 Gy) using 6 Mev photons for 5-6.5 weeks. Boosts were given at the primary tumour site in 336 patients (78%), by electron therapy (88 patients), iridium-192 (247 patients) or photons (one patient). A total of 44 patients (10%) received adjuvant chemotherapy.
RESULTS
The median follow-up period for surviving patients was 84 months (range: 56-172 months). The 5-year actuarial rate of local recurrence was 6% (312 patients at risk), and the 10-year rate was 10% (52 patients at risk). Very young patients (aged 34 years at diagnosis) had a 5-year actuarial rate of local recurrence of 13% compared to 5% for older patients (P = 0.04). Neither the total dose to the primary site nor the boost technique influenced local recurrence. The 5-year freedom from distant relapse was 83%. The side effects included rib fractures (2%), symptomatic pneumonitis (3%), fatty necrosis or fibrosis requiring surgery (4%), and moderate-severe oedema of the arm (7%).
CONCLUSIONS
The long-term data show that CS+RT for UICC stage I or II breast cancer results in low rates of local recurrence which are influenced by age at diagnosis, but not by radiation dose or boost technique. These results confirm those of other international series that CS+RT is a safe alternative to mastectomy for most women with operable breast cancer.
登录
查看更多内容
影响因子：
158.5
作者：
FISHER, B;REDMOND, C;FOSTER, R
通讯作者：
FOSTER, R
影响因子：
158.5
作者：
FISHER, B;REDMOND, C;SIDOROVICH, L
通讯作者：
SIDOROVICH, L
影响因子：
158.5
作者：
FISHER, B;BAUER, M;RUSSELL, I
通讯作者：
RUSSELL, I
影响因子：
45.3
作者：
GELMAN, R;GELBER, R;HARRIS, JR
通讯作者：
HARRIS, JR