Krauss Daniel J, Kestin Larry L, Mitchell Christina, Martinez Alvaro A, Vicini Frank A
Department of Radiation Oncology, William Beaumont Hospital, 3601 W. 13 Mile Road, Royal Oak, MI 48072, USA.
Int J Radiat Oncol Biol Phys. 2004 Nov 1;60(3):731-40. doi: 10.1016/j.ijrobp.2004.04.010.
The purpose of this analysis was to evaluate patterns and rates of ipsilateral breast tumor recurrence (IBTR) over time based on the type of failure (true recurrence/marginal miss [TR/MM] vs. elsewhere [E]) and to compare these to rates of contralateral failure in women with Stages I/II breast cancer treated with conservative surgery (CS) and radiation therapy (RT).
Between 1980 and 1997, 1448 patients with Stages I/II invasive breast carcinoma were treated with CS and RT to a median total dose of >60 Gy. IBTRs were analyzed in terms of their location as follows: TR/MM, referring to those occurring in the same quadrant, and E, referring to the development of a malignancy remote from the index lesion. Outcomes were characterized in terms of their temporal recurrence patterns and correlated with rates of contralateral breast failure (CL). The median follow-up was 8.5 years.
A total of 79 ipsilateral and 98 contralateral failures were observed during the follow-up period corresponding to 5-, 10-, and 15-year actuarial rates of 2%, 7%, and 10% and 4%, 9%, and 12% respectively. Fifty-nine ipsilateral failures (74.7%) were designated as TR/MM and 20 (25.3%) as E. The corresponding 5-, 10-, and 15-year actuarial rates of TR/MM and E failures were 2%, 5%, and 8% and 0.1%, 2%, and 3%, respectively. The median times to total ipsilateral, TR/MM, E, and contralateral failure were 6.5, 5.7, 7.4, and 5.2 years, respectively. Between 0 and 5 years of follow-up, E failures represented 7% of the total ipsilateral failures observed. From 5-10 and 10-15 years, E failures represented 39% and 27% of the total, respectively (p = 0.01). Contralateral failure was significantly more likely to occur in the first 5 years of follow-up than IBTR, accounting for 50 (63.3%) of the 79 failures in that interval (p = 0.02). No significant differences in survival rates were detected between any of the various failure types. On multivariate analysis, only reduced time to tumor recurrence was found to be adversely associated with overall survival.
The rates and patterns of IBTR vary with time and, after 5 years, approach the rates of development of a contralateral breast cancer. E failures are, overall, less frequent than TR/MM but contribute increasingly to the IBTR rate after 5 years. Time to tumor recurrence is the most reliable predictor of prognosis after IBTR.
本分析的目的是根据失败类型（真性复发/边缘遗漏[TR/MM]与其他部位[E]）评估同侧乳腺肿瘤复发（IBTR）随时间变化的模式和发生率，并将其与接受保乳手术（CS）和放射治疗（RT）的I/II期乳腺癌女性的对侧失败发生率进行比较。
1980年至1997年间，1448例I/II期浸润性乳腺癌患者接受了CS和RT治疗，中位总剂量>60 Gy。根据IBTR的位置进行如下分析：TR/MM，指发生在同一象限的复发；E，指远离索引病变处发生的恶性肿瘤。根据其时间复发模式对结果进行特征描述，并与对侧乳腺失败（CL）发生率相关联。中位随访时间为8.5年。
随访期间共观察到79例同侧失败和98例对侧失败，对应的5年、10年和15年精算发生率分别为2%、7%和10%以及4%、9%和12%。59例同侧失败（74.7%）被指定为TR/MM，20例（25.3%）为E。TR/MM和E失败对应的5年、10年和15年精算发生率分别为2%、5%和8%以及0.1%、2%和3%。同侧总失败、TR/MM、E和对侧失败的中位时间分别为6.5年、5.7年、7.4年和5.2年。在随访的0至5年期间，E失败占观察到的同侧总失败的7%。在5至10年和10至15年期间，E失败分别占总数的39%和27%（p = 0.01）。对侧失败在随访的前5年比IBTR更有可能发生，在该时间段的79例失败中占50例（63.3%）（p = 0.02）。在任何不同的失败类型之间均未检测到生存率的显著差异。多因素分析显示，只有肿瘤复发时间缩短与总生存率呈负相关。
IBTR的发生率和模式随时间变化，5年后接近对侧乳腺癌的发生速率。总体而言，E失败比TR/MM少见，但在5年后对IBTR发生率的贡献越来越大。肿瘤复发时间是IBTR后预后最可靠的预测指标。
