Nakamura Shelley, Woo Carol, Silberman Howard, Streeter Oscar E, Lewinsky Bernard S, Silverstein Melvin J
Keck School of Medicine, University of Southern California, USC/Norris Comprehensive Cancer Center, Los Angeles, CA, USA.
Am J Surg. 2002 Nov;184(5):403-9. doi: 10.1016/s0002-9610(02)01011-5.
Breast conservation therapy is a practical alternative to mastectomy for the treatment of ductal carcinoma in situ (DCIS). The role of radiation therapy after excision for DCIS has been debated, however, its value in reducing recurrence has been proven by multiple prospective randomized trials and is well accepted.
We examined a prospective database of 260 patients treated for DCIS with excision and radiation from 1979 to 2002. Two different treatment regimens were examined for local recurrence-free survival. Patients treated with radiation therapy 4 days per week were compared with patients treated 5 days per week. The total doses were similar for both groups; boost types differed. Local recurrence as a function of other factors, including nuclear grade, comedonecrosis, and margin width was evaluated.
The median time to local recurrence was 61 months for patients treated 4 days per week compared with 52 months for patients treated 5 days per week (P = not significant). There was no statistical difference in the Kaplan-Meier detailing the probability of local recurrence-free survival for patients treated 4 days per week versus patients treated 5 days per week. Overall, cosmetic results between the two groups were equivalent.
The comparison of two different radiation treatment regimens shows no difference in local disease-free survival or cosmetic result.
保乳治疗是治疗导管原位癌（DCIS）时乳房切除术的一种切实可行的替代方案。然而，DCIS切除术后放疗的作用一直存在争议，其在降低复发率方面的价值已被多项前瞻性随机试验证实并得到广泛认可。
我们研究了1979年至2002年期间接受DCIS切除及放疗的260例患者的前瞻性数据库。针对局部无复发生存情况，研究了两种不同的治疗方案。将每周放疗4天的患者与每周放疗5天的患者进行比较。两组的总剂量相似；增强放疗类型不同。评估局部复发与其他因素的关系，包括核分级、粉刺样坏死和切缘宽度。
每周放疗4天的患者局部复发的中位时间为61个月，而每周放疗5天的患者为52个月（P值无统计学意义）。在详细描述每周放疗4天的患者与每周放疗5天的患者局部无复发生存概率的Kaplan-Meier曲线中，无统计学差异。总体而言，两组的美容效果相当。
两种不同放疗方案的比较显示，局部无病生存率或美容效果无差异。
