Fujishiro S, Mitsumori M, Kokubo M, Nagata Y, Sasai K, Mise K, Kodama H, Hiroka M
Department of Therapeutic Radiology and Oncology, Kyoto University Graduate School of Medicine, Japan.
Breast Cancer. 2000 Jan;7(1):57-63. doi: 10.1007/BF02967189.
The cosmetic and functional results of breast conserving therapy for early breast cancer were evaluated. These are important endpoints in the assessment of breast conserving therapy in addition to tumor control and survival. The factors suspected to influence cosmesis were also analyzed.
In 206 patients with stage I and II breast cancer treated by wide excision and axillary dissection followed by radiation therapy, the cosmetic results and complications were analyzed. The cosmetic outcome was assessed by a scoring method and breast retraction assessment (BRA). As complications, arm edema and restriction of shoulder movement and late skin reactions were analyzed.
Of the 206 patients 92% showed an excellent to good cosmetic score before radiation therapy. The score deteriorated, but gradually improved and stabilized after 1 year. Eighty-one percent of the patients had an excellent to good cosmetic score at 3 years. The BRA of the 206 patients was 1.8 cm on average before radiation therapy. It increased to 2.3 cm after termination of radiation therapy, and did not change thereafter. Tumor size over 2 cm (p = 0.005) and tumors in the inner quadrant (p = 0.003) were factors which negatively affected the cosmetic score at 3 years. Tumor size over 2 cm (p = 0.003), tumors in the upper quadrant (p = 0.005), or a nipple-tumor distance of more than 2 cm (p = 0.01) were also negative factors for the BRA at 3 years. Arm edema, restriction of shoulder movement, and late skin reaction were generally mild, and were observed in 12%, 0% and 34% of patients at 3 years, respectively.
The overall cosmetic results of breast conserving therapy are acceptable and the complication rate is low. Tumor characteristics, tumor size, location and nipple-tumor distance are factors that affect cosmesis.
对早期乳腺癌保乳治疗的美容效果和功能结果进行了评估。除肿瘤控制和生存外，这些是评估保乳治疗的重要终点。还分析了怀疑影响美容效果的因素。
对206例接受广泛切除和腋窝清扫并随后进行放射治疗的I期和II期乳腺癌患者的美容效果和并发症进行了分析。通过评分方法和乳房回缩评估（BRA）对美容结果进行评估。作为并发症，分析了手臂水肿、肩部活动受限和晚期皮肤反应。
206例患者中，92%在放疗前美容评分为优至良。评分有所下降，但在1年后逐渐改善并稳定。81%的患者在3年时美容评分为优至良。206例患者放疗前BRA平均为1.8 cm。放疗结束后增加至2.3 cm，此后未再变化。肿瘤大小超过2 cm（p = 0.005）和内象限肿瘤（p = 0.003）是对3年时美容评分有负面影响的因素。肿瘤大小超过2 cm（p = 0.003）、上象限肿瘤（p = 0.005）或乳头-肿瘤距离超过2 cm（p = 0.01）也是3年时BRA的负面因素。手臂水肿、肩部活动受限和晚期皮肤反应一般较轻，3年时分别在12%、0%和34%的患者中观察到。
保乳治疗的总体美容效果可以接受，并发症发生率低。肿瘤特征、肿瘤大小、位置和乳头-肿瘤距离是影响美容效果的因素。
