Pierce S M, Recht A, Lingos T I, Abner A, Vicini F, Silver B, Herzog A, Harris J R
Joint Center for Radiation Therapy, Boston, MA 02115.
Int J Radiat Oncol Biol Phys. 1992;23(5):915-23. doi: 10.1016/0360-3016(92)90895-o.
The frequency of brachial plexopathy, rib fracture, tissue necrosis, pericarditis, and second non-breast malignancies occurring in the treatment field among 1624 patients with early stage breast cancer treated with conservative surgery and radiation therapy at the Joint Center for Radiation Therapy between 1968 and 1985 is reported. The median follow-up time for survivors was 79 months (range 5-233 months). Brachial plexopathy was related to the use of a third field, the use of chemotherapy and the total dose to the axilla. Brachial plexopathy developed in 20 of 1117 women (1.8%) who received supraclavicular irradiation with or without axillary irradiation. The median time to its occurrence was 10.5 months (range 1.5-77 mo), and the majority (80%) of cases completely resolved. Among patients treated with a three-field technique, the incidence of brachial plexopathy was 1.3% (13/991) in patients treated with a dose to the axilla of less than or equal to 50 Gy, compared with 5.6% (7/126) in women treated with an axillary dose of greater than 50 Gy. The incidence of brachial plexopathy was 4.5% (15/330) among patients receiving chemotherapy, compared with 0.6% (5/787) when chemotherapy was not used (p less than 0.0001). Rib fracture was seen in 29 patients (1.8%), at a median time of 12 months following treatment (range 1-57). In all cases, the rib fracture healed without intervention. The incidence of rib fracture was 2.2% (28/1300) among patients treated on a 4 MV linear accelerator, compared with 0.4% (1/276) for patients treated on a 6 or 8 MV machine (p = 0.05). Of patients treated on a 4 MV machine, 0.4% (1/279) developed a rib fracture when a whole breast dose of 45 Gy or less was given, 1.4% (10/725) after receiving between 45 and 50 Gy, and 5.7% (17/296) following 50 Gy or higher. Tissue necrosis requiring surgical correction developed in three patients (0.18%) 22, 25, and 114 months after treatment. Presumed pericarditis (requiring hospitalization) was seen in 0.4% of women (3/831) who received radiation therapy to the left breast 2, 2, and 11 months after the start of treatment. Three women (0.18%) developed sarcomas in the treatments field at 72, 107, and 110 months, for a 10-year actuarial rate of 0.8%. Two of these sarcomas developed in areas of probable match-line overlap. One patient (0.06%) developed an in-field basal cell carcinoma at 42 months. In conclusion, the risk of significant complications following conservative surgery and radiation therapy for early stage breast cancer is low.(ABSTRACT TRUNCATED AT 400 WORDS)
报告了1968年至1985年间在联合放射治疗中心接受保守手术和放射治疗的1624例早期乳腺癌患者中，治疗区域发生臂丛神经病变、肋骨骨折、组织坏死、心包炎和第二原发性非乳腺癌的频率。幸存者的中位随访时间为79个月（范围5 - 233个月）。臂丛神经病变与第三野的使用、化疗的使用以及腋窝的总剂量有关。在1117例接受或未接受腋窝照射的锁骨上照射的女性中，有20例（1.8%）发生了臂丛神经病变。其发生的中位时间为10.5个月（范围1.5 - 77个月），大多数（80%）病例完全缓解。在采用三野技术治疗的患者中，腋窝剂量小于或等于50 Gy的患者臂丛神经病变的发生率为1.3%（13/991），而腋窝剂量大于50 Gy的女性患者中这一发生率为5.6%（7/126）。接受化疗的患者中臂丛神经病变的发生率为4.5%（15/330），未使用化疗时为0.6%（5/787）（p小于0.0001）。29例患者（1.8%）出现肋骨骨折，中位时间为治疗后12个月（范围1 - 57个月）。所有病例的肋骨骨折均未经干预而愈合。在使用4 MV直线加速器治疗的患者中，肋骨骨折的发生率为2.2%（28/1300），而使用6或8 MV机器治疗的患者中为0.4%（1/276）（p = 0.05）。在使用4 MV机器治疗的患者中，全乳剂量为45 Gy或更低时，0.4%（1/279）发生肋骨骨折，接受45至50 Gy剂量后为1.4%（10/725），50 Gy或更高剂量后为5.7%（17/296）。需要手术矫正的组织坏死在治疗后22、25和114个月发生在3例患者（0.18%）中。在开始治疗后2、2和11个月，接受左乳放射治疗的女性中有0.4%（3/831）出现疑似心包炎（需要住院治疗）。3例女性（0.18%）在治疗区域于72、107和110个月发生肉瘤，10年精算发生率为0.8%。其中2例肉瘤发生在可能的匹配线重叠区域。1例患者（0.06%）在42个月时发生野内基底细胞癌。总之，早期乳腺癌保守手术和放射治疗后发生严重并发症的风险较低。（摘要截短至400字）
