Arthur Douglas W, Cuttino Laurie W, Neuschatz Andrew C, Koo Derrick T, Morris Monica M, Bear Harry D, Kaplan Brian J, Dawson Kathy, Wazer David E
Deparment of Radiation Oncology, Virginia Commonwealth University, Medical College of Virginia Campus, 401 College Street, Box 58, Richmond, Virginia 23298, USA.
Ann Surg Oncol. 2006 Jun;13(6):794-801. doi: 10.1245/ASO.2006.04.002. Epub 2006 Apr 14.
We evaluated the necessity of a tumor bed boost after whole-breast radiotherapy for early-stage breast cancer after breast-conserving surgery and negative re-excision.
Of patients treated at the Virginia Commonwealth and Tufts Universities with breast-conservation therapy for early-stage breast cancer between 1983 and 1999, 205 required re-excision of the tumor cavity to obtain clear margins and were found to be without residual disease. Adjuvant conventionally fractionated whole-breast radiotherapy was given to a total dose of 50 Gy in 25 fractions. The tumor bed boost was omitted.
The median follow-up was 98 months (range, 6-229 months). The tumor histological diagnosis was primarily infiltrating ductal carcinoma (183 cases; 89%). Nodal involvement was documented in 49 cases (24%). There were four documented recurrences at the tumor bed site. Five in-breast recurrences were documented to be in a location removed from the tumor bed. The overall Kaplan-Meier 15-year in-breast control rate was 92.4%, and the freedom from true recurrence rate was 97.6%.
The findings support the concept that postlumpectomy radiotherapy can be tailored according to the degree of surgical resection. There is an easily identifiable subgroup of patients who can avoid a tumor bed boost, thus resulting in a reduced treatment time and improved cosmesis, while maintaining local control rates that approach 100%. The data suggest that in patients who undergo a negative re-excision, treatment with whole-breast radiotherapy to 50 Gy is a sufficient dose to maximally reduce the risk of local recurrence.
我们评估了保乳手术及再次切除阴性后的早期乳腺癌患者全乳放疗后瘤床加量的必要性。
1983年至1999年间在弗吉尼亚联邦大学和塔夫茨大学接受早期乳腺癌保乳治疗的患者中，205例需要再次切除肿瘤腔以获得切缘阴性，且未发现残留疾病。给予辅助常规分割全乳放疗，总剂量50Gy，分25次。未进行瘤床加量。
中位随访时间为98个月（范围6 - 229个月）。肿瘤组织学诊断主要为浸润性导管癌（183例；89%）。49例（24%）有淋巴结受累记录。瘤床部位有4例复发记录。另有5例乳腺内复发记录显示位于远离瘤床的部位。总体Kaplan-Meier 15年乳腺内控制率为92.4%，无真性复发率为97.6%。
这些发现支持了保乳术后放疗可根据手术切除程度进行调整的概念。有一个易于识别的患者亚组可以避免瘤床加量，从而缩短治疗时间并改善美容效果，同时保持接近100%的局部控制率。数据表明，对于再次切除阴性的患者，全乳放疗至50Gy是最大程度降低局部复发风险的足够剂量。
