Moreno F, Guedea F, Lopez Y, Ferrer F, Gutierrez C, Petriz L, Pera J
Department of Radiation Oncology, Institut Català d'Oncologia, Barcelona, Spain.
Int J Radiat Oncol Biol Phys. 2000 Oct 1;48(3):757-65. doi: 10.1016/s0360-3016(00)00676-3.
To provide more information for the clinician and to analyze the impact of the boost with brachytherapy on the local disease-free survival (LDFS), disease-free survival (DFS), specific overall survival (OS), and cosmesis, a retrospective study of external radiation therapy and (192)Ir implantation in early breast cancer at Institut Català d'Oncologia has been undertaken.
From 1986 to 1996, 530 patients were selected for this study with a median follow-up period of 39.5 months (range, 10-115 months). External radiation therapy (combined with brachytherapy) was administered postoperatively to the breast in all patients. Mean given dose was 48.7 Gy (range, 42-52 Gy) with external radiation therapy to the breast, and 16.8 Gy (range, 10-27 Gy) was the mean dose with brachytherapy. Variables have been tested for cosmesis. Univariate and multivariate analysis have also been carried out.
Mean age of the patients was 54 years (range, 28-81 years). Stages were distributed as follows: 350 patients (66%) in Stage I, 173 in Stage II (32.8%), and 7 in Stage III (1.1%). Pathologic distribution was 445 patients with infiltrating ductal carcinoma (84%), 20 patients with infiltrating lobular carcinoma (4%), and 65 patients (12%) of a miscellaneous group. OS for the entire group was 89.4% and 85.9% at 5 and 7 years respectively. Probability of DFS was 81.7% and 70.1% at 5 and 7 years. The LDFS was 94.9% and 91.7% at 5 and 7 years. The MFS probability was 85.5% and 76.9% at 5 and 7 years, respectively. Univariate analysis demonstrated that age (older than 52 years), premenopausal status, moderate and high histologic grades (Grades II-III), and presence of intraductal comedocarcinoma were prognostic factors for local relapse. Multivariate analysis for local disease-free survival demonstrated that only perineural or muscular infiltration remain as prognostic factors. Tumor dose bed of 70 Gy or higher had a negative impact in breast subcutaneous fibrosis, whereas dose rate lower than 65 cGy/h was better for skin color at 2 years.
We conclude that patients with early-stage breast cancer undergoing external radiotherapy and LDR brachytherapy can be effectively managed. Overall survival, long-term local control, and cosmetic control are excellent.
为临床医生提供更多信息，并分析近距离放射治疗加量对局部无病生存率（LDFS）、无病生存率（DFS）、特定总生存率（OS）和美容效果的影响，我们对加泰罗尼亚肿瘤研究所早期乳腺癌患者进行外照射放疗和（192）铱植入的情况开展了一项回顾性研究。
1986年至1996年，选取530例患者进行本研究，中位随访期为39.5个月（范围10 - 115个月）。所有患者术后均接受乳房外照射放疗（联合近距离放射治疗）。乳房外照射放疗的平均给予剂量为48.7 Gy（范围42 - 52 Gy），近距离放射治疗的平均剂量为16.8 Gy（范围10 - 27 Gy）。对美容效果相关变量进行了检测。还进行了单因素和多因素分析。
患者的平均年龄为54岁（范围28 - 81岁）。分期分布如下：I期350例患者（66%），II期173例（32.8%），III期7例（1.1%）。病理分布为445例浸润性导管癌患者（84%），20例浸润性小叶癌患者（4%），以及65例（12%）其他类型患者。全组5年和7年的OS分别为89.4%和85.9%。DFS概率在5年和7年分别为81.7%和70.1%。LDFS在5年和7年分别为94.9%和91.7%。MFS概率在5年和7年分别为85.5%和76.9%。单因素分析表明，年龄（大于52岁）、绝经前状态、组织学中高分级（II - III级）以及导管内粉刺癌的存在是局部复发的预后因素。局部无病生存率的多因素分析表明，只有神经周围或肌肉浸润仍是预后因素。70 Gy或更高的肿瘤剂量对乳房皮下纤维化有负面影响，而低于65 cGy/h的剂量率在2年时对皮肤颜色更有利。
我们得出结论，接受外照射放疗和低剂量率近距离放射治疗的早期乳腺癌患者能够得到有效治疗。总体生存率、长期局部控制和美容效果均良好。
