采用标准放疗加或不加额外放疗治疗乳腺癌后的复发率。

Recurrence rates after treatment of breast cancer with standard radiotherapy with or without additional radiation.

作者信息

Bartelink H, Horiot J C, Poortmans P, Struikmans H, Van den Bogaert W, Barillot I, Fourquet A, Borger J, Jager J, Hoogenraad W, Collette L, Pierart M

机构信息

Department of Radiation Oncology, the Netherlands Cancer Institute, Amsterdam.

出版信息

N Engl J Med. 2001 Nov 8;345(19):1378-87. doi: 10.1056/NEJMoa010874.

DOI:10.1056/NEJMoa010874

PMID:11794170

Abstract

BACKGROUND

Radiotherapy prevents local recurrence of breast cancer after breast-conserving surgery. We evaluated the effect of a supplementary dose of radiation to the tumor bed on the rates of local recurrence among patients who received radiotherapy after breast-conserving surgery for early breast cancer.

METHODS

After lumpectomy and axillary dissection, patients with stage I or II breast cancer received 50 Gy of radiation to the whole breast in 2-Gy fractions over a five-week period. Patients with a microscopically complete excision were randomly assigned to receive either no further local treatment (2657 patients) or an additional localized dose of 16 Gy, usually given in eight fractions by means of an external electron beam (2661 patients).

RESULTS

During a median follow-up period of 5.1 years, local recurrences were observed in 182 of the 2657 patients in the standard-treatment group and 109 of the 2661 patients in the additional-radiation group. The five-year actuarial rates of local recurrence were 7.3 percent (95 percent confidence interval, 6.8 to 7.6 percent) and 4.3 percent (95 percent confidence interval, 3.8 to 4.7 percent), respectively (P<0.001), yielding a hazard ratio for local recurrence of 0.59 (99 percent confidence interval, 0.43 to 0.81) associated with an additional dose. Patients 40 years old or younger benefited most; at five years, their rate of local recurrence was 19.5 percent with standard treatment and 10.2 percent with additional radiation (hazard ratio, 0.46 [99 percent confidence interval, 0.23 to 0.89]; P=0.002). At five years in the age group 41 to 50 years old, no differences were found in rates of metastasis or overall survival (which were 87 and 91 percent, respectively).

CONCLUSIONS

In patients with early breast cancer who undergo breast-conserving surgery and receive 50 Gy of radiation to the whole breast, an additional dose of 16 Gy of radiation to the tumor bed reduces the risk of local recurrence, especially in patients younger than 50 years of age.

摘要

背景

放疗可预防保乳手术后乳腺癌的局部复发。我们评估了对肿瘤床追加放疗剂量对早期乳腺癌保乳手术后接受放疗患者局部复发率的影响。

方法

在进行肿块切除和腋窝淋巴结清扫术后，I期或II期乳腺癌患者在五周内以2Gy的分次剂量接受全乳50Gy的放疗。显微镜下切除完全的患者被随机分配接受进一步的局部治疗（2657例患者）或额外的16Gy局部剂量放疗，通常通过外照射电子束分八次给予（2661例患者）。

结果

在中位随访期5.1年期间，标准治疗组的2657例患者中有182例出现局部复发，追加放疗组的2661例患者中有109例出现局部复发。局部复发的五年精算率分别为7.3%（95%置信区间，6.8%至7.6%）和4.3%（95%置信区间，3.8%至4.7%）（P<0.001），追加剂量相关的局部复发风险比为0.59（99%置信区间，0.43至0.81）。40岁及以下的患者受益最大；五年时，标准治疗组的局部复发率为19.5%，追加放疗组为10.2%（风险比，0.46 [99%置信区间，0.23至0.89]；P=0.002）。在41至50岁年龄组中，五年时转移率和总生存率无差异（分别为87%和91%）。