乳腺癌患者锁骨上淋巴结放疗后是否存在臂丛神经病变的终身风险？

Is there a life-long risk of brachial plexopathy after radiotherapy of supraclavicular lymph nodes in breast cancer patients?

作者信息

Bajrovic Amira, Rades Dirk, Fehlauer Fabian, Tribius Silke, Hoeller Ulrike, Rudat Volker, Jung Horst, Alberti Winfried

机构信息

Department of Radiotherapy and Radiation Oncology, University Hospital Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany.

出版信息

Radiother Oncol. 2004 Jun;71(3):297-301. doi: 10.1016/j.radonc.2004.03.005.

DOI:10.1016/j.radonc.2004.03.005

PMID:15172145

Abstract

BACKGROUND AND PURPOSE

To contribute to the question whether the risk of radiation-related brachial plexopathy increases, remains constant or decreases with time after treatment.

PATIENTS AND METHODS

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].

RESULTS

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.

CONCLUSIONS

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.

摘要

背景与目的

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。

患者与方法

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。

结果

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。