Jobsen Jan J, van der Palen Job, Ong Francisca, Meerwaldt Jacobus H
Department of Radiation Oncology, Medisch Spectrum Twente, Haaksbergerstraat 55, 7513 ER, Enschede, The Netherlands.
Breast Cancer Res Treat. 2006 Oct;99(3):289-94. doi: 10.1007/s10549-006-9217-9. Epub 2006 Apr 5.
To look at the optimum timing of radiotherapy in breast-conserving therapy (BCT) in relation to outcome in breast cancer.
We analyzed 1473 BCT on 1446 breast cancer patients from our prospective cohort, stage I or II, node-negative, and without adjuvant systemic therapy. Timing was defined as time from lumpectomy till radiotherapy. Patients were categorized into three timing tertiles: 1-36 days, 37-53 days, and 54-112 days.
The 10-year local relapse-free survival rates did not show significant differences between the three groups. The 10-year Distant Metastasis-Free Survival (DMFS) was 78.9% for the first tertile, versus 86.1% (HR 0.6; P = 0.009) for the second, and 90.7% (HR 0.3; P < 0.001) for the third. The 10-year Disease-specific Survival (DSS) was 83.8% for the first tertile, versus 90.6% (HR 0.5; P = 0.007) for the second, and 97.2% (HR 02; P < 0.001) for the third. Also in multivariate Cox regression analysis the second (HR 0.6; P = 0.053) and the third tertile (HR 0.3; P = 0.002) had significantly better DSS.
Timing of radiotherapy in BCT for breast cancer seems to be highly important in relation to survival. This study shows a 40-70% relative survival benefit with timing after 36 days.
探讨保乳治疗（BCT）中放射治疗的最佳时机与乳腺癌预后的关系。
我们分析了来自前瞻性队列的1446例I期或II期、淋巴结阴性且未接受辅助全身治疗的乳腺癌患者的1473例保乳治疗。放疗时机定义为从肿块切除到放疗的时间。患者被分为三个时间三分位数组：1 - 36天、37 - 53天和54 - 112天。
三组的10年局部无复发生存率无显著差异。第一个三分位数组的10年无远处转移生存率（DMFS）为78.9%，第二个为86.1%（风险比[HR] 0.6；P = 0.009），第三个为90.7%（HR 0.3；P < 0.001）。第一个三分位数组的10年疾病特异性生存率（DSS）为83.8%，第二个为90.6%（HR 0.5；P = 0.007），第三个为97.2%（HR 0.2；P < 0.001）。在多变量Cox回归分析中，第二个三分位数组（HR 0.6；P = 0.053）和第三个三分位数组（HR 0.3；P = 0.002）的DSS也显著更好。
乳腺癌保乳治疗中放疗时机似乎对生存至关重要。本研究表明，放疗时机在36天后相对生存获益为40% - 70%。
