Deutsch M, Flickinger J C
Department of Radiation Oncology, University of Pittsburgh Medical Center, Pennsylvania 15213, USA.
Am J Clin Oncol. 2001 Apr;24(2):172-6. doi: 10.1097/00000421-200104000-00015.
There is little, if any, difference in disease-free or overall survival for patients with stage I and II breast cancer treated by either breast conservation therapy or mastectomy. With either treatment, there may be cosmetic and functional problems related to arm edema, limited shoulder motion, and shoulder pain. The extent to which factors such as surgery, radiotherapy, systemic therapy, and patient characteristics affect development of arm edema, limited shoulder motion, and shoulder pain is not well documented. We undertook a prospective study of arm edema, limited shoulder motion, and shoulder pain in every patient (N = 331) seen during a 6-month period for follow-up after radiotherapy postlumpectomy or mastectomy for primary breast cancer. Local treatment included lumpectomy and breast irradiation with (n = 232) or without (n = 97) axillary dissection. Ten other women underwent mastectomy and postoperative radiotherapy. Doses to each region treated were 50 Gy in 25 fractions. The operative area was treated with an additional 1,000 Gy in approximately 60% of patients. Twelve patients received axillary irradiation without axillary dissection, and 11 patients received supraclavicular irradiation. Chemotherapy with or without tamoxifen was used in 71 patients and tamoxifen alone was used in 150 patients. One hundred ten patients did not receive any adjuvant therapy. Ipsilateral arm edema occurred in 20 women (6.0%), limited ipsilateral shoulder motion in 5 (1.5%), and ipsilateral shoulder pain in 5 (1.5%). Edema was mild (1+) in 15 patients and moderate (2+) in five patients. Multivariate analysis revealed that the risk of arm edema was significantly increased in black women (p = 0.005, 4/18 versus 16/313 whites) and with mastectomy (p = 0.048, 2/10 versus 18/321 with lumpectomy). There is a low incidence of arm edema, decreased range of motion of the ipsilateral shoulder, and shoulder-arm pain in patients undergoing postlumpectomy or postmastectomy radiotherapy. The risk of arm edema is increased in black women and in patients after mastectomy as opposed to lumpectomy.
对于接受保乳治疗或乳房切除术的I期和II期乳腺癌患者，其无病生存率或总生存率几乎没有差异（即便有差异也很小）。无论采用哪种治疗方法，都可能存在与手臂水肿、肩部活动受限和肩部疼痛相关的美容和功能问题。手术、放疗、全身治疗以及患者特征等因素在多大程度上影响手臂水肿、肩部活动受限和肩部疼痛的发生，目前尚无充分的文献记载。我们对331例患者进行了一项前瞻性研究，这些患者均在接受原发性乳腺癌乳房肿瘤切除术或乳房切除术后放疗6个月的随访期间前来就诊。局部治疗包括乳房肿瘤切除术以及有（n = 232）或无（n = 97）腋窝淋巴结清扫的乳房照射。另外10名女性接受了乳房切除术和术后放疗。每个治疗区域的剂量为25次分割照射共50 Gy。大约60%的患者对手术区域额外给予1000 Gy照射。12例患者未进行腋窝淋巴结清扫但接受了腋窝照射，11例患者接受了锁骨上照射。71例患者接受了含或不含他莫昔芬的化疗，150例患者仅使用了他莫昔芬。110例患者未接受任何辅助治疗。20名女性出现同侧手臂水肿（6.0%），5名出现同侧肩部活动受限（1.5%），5名出现同侧肩部疼痛（1.5%）。15例患者水肿为轻度（1+），5例为中度（2+）。多因素分析显示，黑人女性发生手臂水肿的风险显著增加（p = 0.005，黑人18例中有4例，白人313例中有16例），且接受乳房切除术的患者风险增加（p = 0.048，乳房切除术10例中有2例，乳房肿瘤切除术321例中有18例）。接受乳房肿瘤切除术后或乳房切除术后放疗的患者中，手臂水肿、同侧肩部活动范围减小和肩臂疼痛的发生率较低。与乳房肿瘤切除术患者相比，黑人女性和乳房切除术后患者发生手臂水肿的风险增加。
