Metz J M, Schultz D J, Fox K, Mathews A, Glick J, Solin L J
Department of Radiation Oncology, Hospital of the University of Pennsylvania, Philadelphia 19104, USA.
Cancer J. 2000 Sep-Oct;6(5):324-30.
The success of adjuvant chemotherapy has prolonged the interval between surgery and postmastectomy radiation therapy for high-risk breast cancer patients. The purpose of this study is to determine whether a delay in radiation therapy after mastectomy results in an increased risk of local-regional recurrence of breast cancer.
A retrospective review was performed of the University of Pennsylvania database of 221 patients with high-risk breast cancer treated with postmastectomy radiation therapy between 1977 and 1992. The surgery to postmastectomy radiation therapy time interval was 2 months or less in 82 patients (37%), 2.1 to 6 months in 50 patients (23%), and greater than 6 months in 89 patients (40%). Adjuvant chemotherapy was utilized in 151 patients (68%). The median follow-up was 4.3 years after postmastectomy radiation therapy.
Because the three groups showed significant differences for a number of prognostic factors, outcomes are reported in terms of local-regional recurrence only and not survival. The actuarial rate of local-regional recurrence at 8 years was 13% for patients with a surgery to radiation therapy interval of 2 months or less, 4% for those with an interval of 2.1 to 6 months, and 12% for those with an interval of greater than 6 months. A similar analysis performed for 4 months or less versus greater than 4 months between surgery and postmastectomy radiation therapy showed no difference in local-regional recurrence (11% versus 10%, respectively).
A delay in the institution of postmastectomy radiation therapy in favor of the prolongation of chemotherapy for high-risk breast cancer patients does not adversely affect outcome for local-regional recurrence at 8 years.
辅助化疗的成功延长了高危乳腺癌患者手术与乳房切除术后放疗之间的间隔时间。本研究的目的是确定乳房切除术后放疗延迟是否会增加乳腺癌局部区域复发的风险。
对宾夕法尼亚大学数据库中1977年至1992年间接受乳房切除术后放疗的221例高危乳腺癌患者进行回顾性分析。手术至乳房切除术后放疗的时间间隔在82例患者（37%）中为2个月或更短，50例患者（23%）中为2.1至6个月，89例患者（40%）中超过6个月。151例患者（68%）接受了辅助化疗术后放疗的中位随访时间为4.3年。
由于三组在一些预后因素上存在显著差异，因此仅报告局部区域复发的结果，而非生存率。手术至放疗间隔为2个月或更短的患者，8年时局部区域复发的精算率为13%；间隔为2.1至6个月的患者为4%；间隔超过6个月的患者为12%。对手术与乳房切除术后放疗间隔4个月或更短与超过4个月的患者进行的类似分析显示，局部区域复发无差异（分别为11%和10%）。
对于高危乳腺癌患者，推迟乳房切除术后放疗以延长化疗时间，不会对8年时的局部区域复发结果产生不利影响。
