Freedman Gary M, Anderson Penny R, Hanlon Alexandra L, Eisenberg Debra F, Nicolaou Nicos
Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA.
Int J Radiat Oncol Biol Phys. 2005 Apr 1;61(5):1328-36. doi: 10.1016/j.ijrobp.2004.08.026.
Most recurrences in the breast after conservative surgery and whole-breast irradiation have been reported to occur within the same quadrant as the initial primary tumor. We analyzed the long-term risk of recurrence by area of the breast after whole-breast irradiation.
In all, 1,990 women with Stage 0-II breast cancer were treated with conservative surgery and whole-breast irradiation from 1970-1998. Stage was ductal carcinoma in situ in 237, T1 in 1273, and T2 in 480 patients. Of 120 local recurrences, 71 were classified as true local (confined to the original quadrant) and 49 as elsewhere (involving outside the original quadrant). Kaplan-Meier methodology was used to calculate 5-year, 10-year, and 15-year rates of recurrence (95% confidence intervals in parentheses). The median follow-up is 80 months.
There was no apparent difference in the 15-year rate of true local vs. elsewhere recurrence, but the time to recurrence was different. The rate of true local recurrence was 2%, 5%, and 7% (5-9%) at 5, 10, and 15 years, respectively. The recurrences elsewhere in the breast were rare at 5 (1%) and 10 (2%) years, but increased to 6 (3-9%) at 15 years. This 15-year rate of elsewhere recurrence was half the rate of contralateral breast cancers of 13% (10-16%).
Recurrence elsewhere in the breast is rare for the first 10 years, but by 15 years is nearly equal to true local recurrence even after whole-breast irradiation. The 15-year rate of elsewhere recurrence was half the rate of contralateral breast cancers. This may indicate a therapeutic effect of whole-breast radiation for other areas of the breast. Very long follow-up will be needed for partial breast irradiation with or without tamoxifen to show that the risk of elsewhere recurrence is not significantly different than after whole-breast irradiation.
据报道，保乳手术及全乳放疗后乳房的大多数复发发生在与初始原发肿瘤相同的象限内。我们分析了全乳放疗后乳房不同区域的长期复发风险。
1970年至1998年期间，共有1990例0-II期乳腺癌女性接受了保乳手术及全乳放疗。其中237例为原位导管癌，1273例为T1期，480例为T2期。在120例局部复发中，71例被归类为真正的局部复发（局限于原象限），49例为其他部位复发（涉及原象限以外）。采用Kaplan-Meier方法计算5年、10年和15年的复发率（括号内为95%置信区间）。中位随访时间为80个月。
真正的局部复发与其他部位复发的15年复发率无明显差异，但复发时间不同。真正的局部复发率在5年、10年和15年分别为2%、5%和7%（5-9%）。乳房其他部位的复发在5年（1%）和10年（2%）时很少见，但在15年时增至6%（3-9%）。这种15年的其他部位复发率是对侧乳腺癌13%（10-16%）的一半。
乳房其他部位的复发在最初10年很少见，但到15年时，即使在全乳放疗后也几乎与真正的局部复发相等。其他部位复发的15年发生率是对侧乳腺癌发生率的一半。这可能表明全乳放疗对乳房其他区域有治疗效果。对于接受或未接受他莫昔芬治疗的部分乳腺照射，需要非常长期的随访来表明其他部位复发的风险与全乳放疗后无显著差异。
