Fowble B L, Solin L J, Schultz D J, Goodman R L
Department of Radiation Oncology, University of Pennsylvania School of Medicine, Philadelphia 19104.
Int J Radiat Oncol Biol Phys. 1991 Jul;21(2):269-77. doi: 10.1016/0360-3016(91)90771-u.
Between 1977 and 1985, 697 women with clinical Stage I or II invasive breast cancer underwent excisional biopsy, axillary dissection, and definitive irradiation. Reexcision of the primary was performed in 330 and residual tumor was identified in 57% of these patients. Margins of resection were assessed in 50% and 257 had final margins of resection that were negative. Four hundred eighty patients had negative axillary dissections and 217 had histologically positive axillary nodes. Median follow-up was 58 months. The 10-year actuarial survival for the entire group was 83% with an NED survival of 73%. The 10-year actuarial survival was 87% for clinical Stage I and 77% for clinical Stage II patients with an NED survival of 79% and 67%, respectively. Patients with histologically negative axillary nodes had a 10-year overall survival of 86% (NED 78%) compared to 74% (NED 66%) for patients with positive nodes. Sixty-one patients developed a recurrence in the treated breast and in seven of these it was associated with simultaneous distant metastases. The cumulative probability of an isolated breast recurrence was 6% at 5 years and 16% at 10 years. The overall breast recurrence rate (+/- distant metastasis) was 8% at 5 years and 18% at 10 years. Breast recurrence was unrelated to T size, clinical stage, or histologic nodal status. The addition of adjuvant chemotherapy significantly decreased the risk of an isolated breast recurrence both at 5 and 10 years; however, there was no significant impact on the overall risk of a breast recurrence. Complications of treatment included moderate arm edema (5%), symptomatic pneumonitis (less than 1%), rib fraction (1%), pericarditis (0%), and brachial plexopathy (less than 1%). Cosmesis was judged to be good to excellent in 93% of patients in 10 years. These results have been achieved in a series of patients who for the most part have been treated by contemporary standards, that is, pathologic assessment of the axilla in all patients, reexcision in 47%, and adjuvant chemotherapy in 77% of node positive patients. Assessment of resection margins, however, was not performed in all patients (50%) and further follow-up in the group of patients with margin assessment will provide long term information on breast recurrence rate in this group of patients.
1977年至1985年间，697例临床I期或II期浸润性乳腺癌女性患者接受了切除活检、腋窝淋巴结清扫及根治性放疗。330例患者接受了原发灶再次切除，其中57%的患者发现有残留肿瘤。对50%的患者评估了切除切缘，257例患者最终切除切缘为阴性。480例患者腋窝淋巴结清扫结果为阴性，217例患者腋窝淋巴结组织学检查呈阳性。中位随访时间为58个月。整个队列的10年精算生存率为83%，无疾病证据（NED）生存率为73%。临床I期患者的10年精算生存率为87%，临床II期患者为77%，NED生存率分别为79%和67%。腋窝淋巴结组织学检查阴性的患者10年总生存率为86%（NED为78%），而淋巴结阳性患者为74%（NED为66%）。61例患者在接受治疗的乳房出现复发，其中7例伴有同时发生的远处转移。孤立性乳房复发的累积概率在5年时为6%，10年时为16%。乳房复发总率（±远处转移）在5年时为8%，10年时为18%。乳房复发与肿瘤大小（T）、临床分期或组织学淋巴结状态无关。辅助化疗的加入显著降低了5年和10年时孤立性乳房复发的风险；然而，对乳房复发的总体风险没有显著影响。治疗并发症包括中度手臂水肿（5%）、有症状的肺炎（小于1%）、肋骨骨折（1%）、心包炎（0%）和臂丛神经病变（小于1%）。10年后93%的患者美容效果判定为良好至优秀。这些结果是在一系列大多按照当代标准进行治疗的患者中取得的，即所有患者均进行腋窝病理评估，47%的患者接受再次切除，77%的淋巴结阳性患者接受辅助化疗。然而，并非所有患者（50%）都评估了切除切缘，对切缘评估组患者的进一步随访将提供该组患者乳房复发率的长期信息。
