Internal mammary nodes in invasive breast carcinoma. To treat or not to treat?
Internal mammary nodes in invasive breast carcinoma. To treat or not to treat?
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浸润性乳腺癌的内乳淋巴结。
DOI：
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发表时间：
2004
期刊：
影响因子：
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通讯作者：
G. Grabenbauer
中科院分区：
文献类型：
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作者：
G. Grabenbauer
背景和目的
根据最近的数据，与外侧位置相比，内侧位置的早期乳腺癌与全身复发和乳腺癌死亡的风险更高相关。本文将重点关注文献数据，并将介绍自己的数据，放射治疗（RT）的预后影响内乳淋巴结（IMNs）的早期乳腺癌患者与内侧半球肿瘤的位置。
患者和方法
评价了最近四个大型系列文献，报告了> 50，000例患者，特别关注肿瘤位置的影响。未对IMN进行系统性RT。在德国埃尔兰根大学放射肿瘤学系，共有822例早期乳腺癌患者（492例为外侧病变，330例为内侧病变）接受了手术和术后RT联合或不联合化疗（1985-1996年）。所有中膜病变患者均采用混合射束方法（50%光子，50%电子）接受IMNs RT，总剂量为50戈伊。在具有侧部病变的患者中，RT仅针对乳房（50.4戈伊总剂量，加强12-16戈伊）。
结果
在所有四项研究中，内侧肿瘤位置的负面影响程度相对相似。根据Zucali等人的研究，远处转移的危险比（HR）为1.29。乳腺癌特异性生存期（BCSS）的HR在1.46（Lohrisch et al.）和1.31（Gaffney等人）。5-高风险内侧和外侧病变的1年全身无病生存率（SDFS）分别为66.3%和74.2%（p < 0.005）。相应的BCSS分别为75.7%和80.8%（p < 0.03，Lohrisch等人）。对于所有822例接受IMN治疗的患者，外侧病变和内侧病变的5年总生存率（OS）分别为76.2%和79.1%（n.s.），外侧和内侧肿瘤的SDFS分别为72.6%和72.9%（n.s.），分别没有一个亚组的内侧肿瘤患者的预后低于外侧病变患者的生存数据。在绝经后女性中，内侧肿瘤患者的OS显著优于外侧肿瘤患者（77.6% vs. 72.7%; p = 0.05）;在接受辅助化疗的患者中，内侧肿瘤患者的SDFS（5年）优于外侧肿瘤患者（80.5% vs. 67.6%; p = 0.02）。
结论
存在一致的文献数据，表明内外象限乳腺癌患者的生存率降低。根据我们的数据，对内侧病变的乳腺癌患者的IMN进行总剂量为50戈伊的RT与OS和SDFS率相关，与外侧肿瘤患者相当。
BACKGROUND AND PURPOSE
According to recent data medial location of early breast cancer was associated with a higher risk of systemic relapse and breast cancer death compared with lateral location. This paper will focus on literature data and will also present own data on the prognostic impact of radiation therapy (RT) to internal mammary nodes (IMNs) in early breast cancer patients with medial hemisphere tumor location.
PATIENTS AND METHODS
Four large recent series of the literature reporting on > 50,000 patients with special focus on the impact of tumor location were evaluated. No systematic RT to IMNs was applied. At the Department of Radiation Oncology, University of Erlangen, Germany, a total of 822 patients (492 with lateral and 330 with medial lesions) with early breast cancer were treated by surgery and postoperative RT with or without chemotherapy (1985-1996). All patients with medial lesions received RT to IMNs by a mixed-beam approach (50% photons, 50% electrons) with a total dose of 50 Gy. In patients with lateral lesions RT was directed to the breast alone (50.4 Gy total dose, boost 12-16 Gy).
RESULTS
The magnitude of the negative impact of medial tumor location was relatively similar in all four studies available. According to Zucali et al., the hazard ratio (HR) for distant metastases was 1.29. The HR for breast cancer-specific survival (BCSS) varied between 1.46 (Lohrisch et al.) and 1.31 (Gaffney et al.). 5-year systemic disease-free survival (SDFS) rates were 66.3% and 74.2% for high-risk medial and lateral lesions, respectively (p < 0.005). Corresponding BCSS were 75.7% and 80.8%, respectively (p < 0.03, Lohrisch et al.). For all 822 patients following treatment on IMNs, 5-year overall survival (OS) for lateral lesions and medial lesions was 76.2% and 79.1% (n.s.), and SDFS for lateral and medial tumors 72.6% and 72.9% (n.s.), respectively. No subgroup could be identified in which prognosis of patients with medial tumors was inferior to survival data for patients with lateral lesions. In postmenopausal women, OS was significantly better for patients with medial versus lateral tumors (77.6% vs. 72.7%; p = 0.05); in patients receiving adjuvant chemotherapy SDFS (5 years) was better for those with medial versus lateral tumors (80.5% vs. 67.6%; p = 0.02).
CONCLUSION
Consistent literature data exist indicating a diminished survival in patients with inner versus outer quadrant breast cancer. According to our data, RT with a total dose of 50 Gy to IMNs in breast cancer patients with medial lesions was associated with OS and SDFS rates comparable to patients with lateral tumors.