McIntosh Alyson, Freedman Gary, Eisenberg Debra, Anderson Penny
Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania 19111, USA.
Am J Clin Oncol. 2007 Apr;30(2):146-51. doi: 10.1097/01.coc.0000251357.45879.7f.
This study examines the risk of local recurrence in a group of patients accepted for radiation therapy after breast-conserving surgery despite having a close or positive resection margin.
Two hundred patients with early-stage breast cancer were treated by radiation with a nonnegative margin < or =2 mm from January 1974 to September 2001. The median age was 61 years. Margins were positive in 29% and close (< or =2 mm) in 71%. The median dose was 64 to 66 Gy. The median follow up was 5.9 years.
The number of resection margins close or positive was 1 in 73% of patients, 2 in 14%, 3 in 1%, and unknown in 12%. The margin location was 23% anterior, 24% posterior, 12% medial, 12% lateral, 17% superior, and 12% inferior. Reasons for not reexcising were advanced age/comorbidities in 7%, anterior location under skin in 25%, posterior location to muscle in 15%, focal involvement in 13%, no extensive intraductal component in 5%, surgeon refusal in 15%, and patient refusal in 20%. There was a strong association between an anterior or posterior margin location and the rationale of no additional breast tissue at the margin to reexcise before radiation. The risk of local recurrence at 5 and 10 years was 3% and 5%, respectively.
Further research of close and positive margins is needed to validate features identified in this series, particularly nonbreast tissue anatomic margins, that are associated with low risks of local recurrence after radiation.
本研究调查了一组保乳手术后接受放射治疗的患者，尽管切缘接近或阳性，但局部复发的风险。
1974年1月至2001年9月，200例早期乳腺癌患者接受了切缘阴性<或=2 mm的放射治疗。中位年龄为61岁。29%的切缘为阳性，71%的切缘接近（<或=2 mm）。中位剂量为64至66 Gy。中位随访时间为5.9年。
73%的患者切缘接近或阳性数量为1个，14%为2个，1%为3个，12%未知。切缘位置为前23%、后24%、内侧12%、外侧12%、上方17%、下方12%。未再次切除的原因包括高龄/合并症7%、皮下前位25%、肌后位15%、局灶性累及13%、无广泛导管内成分5%、外科医生拒绝15%、患者拒绝20%。切缘位于前或后与放疗前切缘处无额外乳腺组织可供再次切除的理由之间存在密切关联。5年和10年局部复发风险分别为3%和5%。
需要对切缘接近和阳性进行进一步研究，以验证本系列中确定的特征，特别是与放疗后局部复发低风险相关的非乳腺组织解剖切缘。
