Bajrovic Amira, Rades Dirk, Fehlauer Fabian, Tribius Silke, Hoeller Ulrike, Rudat Volker, Jung Horst, Alberti Winfried
Department of Radiotherapy and Radiation Oncology, University Hospital Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany.
Radiother Oncol. 2004 Jun;71(3):297-301. doi: 10.1016/j.radonc.2004.03.005.
To contribute to the question whether the risk of radiation-related brachial plexopathy increases, remains constant or decreases with time after treatment.
Between 12/80 and 9/93, 140 breast cancer patients received supraclavicular lymph node irradiation using a telecobalt unit. Total dose was 60 with 3Gy per fraction at a depth of 0.5 cm and 52 with 2.6Gy per fraction to the brachial plexus at a depth of 3 cm. Twenty-eight women received chemotherapy, 34 tamoxifen. Brachial plexopathy was graded using a modified LENT-SOMA score. Actuarial complication-free survival and overall survival were obtained from Kaplan-Meier analysis. The impact of chemotherapy or tamoxifen was tested using the chi2 test. The annual incidence of radiation-related brachial plexopathy was assessed by exponential regression as described by Jung et al. [Radiother Oncol 61 (2001) 233].
Actuarial overall survival was 67.1% after 5 years, 54.0% after 10 years, 49.9% after 15 years, and 44.0% after 20 years. In 19/140 patients, brachial plexopathy grade>/=1 occurred after a median interval of 88 (30-217) months. The percentage of patients being free from plexopathy was 96.1% after 5 years, 75.5% after 10 years, 72.1% after 15 years, and 46.0% after 19 years, respectively. A significant impact of type of surgery, chemotherapy or tamoxifen was not observed. The annual incidence of brachial plexopathy was 2.9% for grade>/=1 lesions and 0.8% for grade>/=3 lesions. The rates did not change significantly with time.
The risk of brachial plexopathy after supraclavicular lymph node irradiation in breast cancer patients remains constant for a considerable portion of the patient's life.
探讨乳腺癌患者锁骨上淋巴结放疗后，与放疗相关的臂丛神经病变风险随时间推移是增加、保持不变还是降低。
1980年12月至1993年9月期间，140例乳腺癌患者接受了钴远距离治疗机锁骨上淋巴结照射。总剂量为60Gy，在深度0.5cm处每次分割剂量为3Gy；在深度3cm处给予臂丛神经52Gy，每次分割剂量为2.6Gy。28例女性接受了化疗，34例接受了他莫昔芬治疗。采用改良的LENT - SOMA评分对臂丛神经病变进行分级。通过Kaplan - Meier分析得出精算无并发症生存率和总生存率。使用卡方检验检测化疗或他莫昔芬的影响。按照Jung等人[《放射肿瘤学》61(2001)233]所述，通过指数回归评估与放疗相关的臂丛神经病变的年发病率。
5年时精算总生存率为67.1%，10年时为54.0%，15年时为49.9%，20年时为44.0%。140例患者中有19例出现臂丛神经病变≥1级，中位间隔时间为88(30 - 217)个月。5年、10年、15年和19年后无臂丛神经病变的患者百分比分别为96.1%、75.5%、72.1%和46.0%。未观察到手术类型、化疗或他莫昔芬有显著影响。臂丛神经病变≥1级病变的年发病率为2.9%，≥3级病变的年发病率为0.8%。发病率随时间未发生显著变化。
乳腺癌患者锁骨上淋巴结放疗后，臂丛神经病变风险在患者生命的相当长一段时间内保持不变。
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