McGuire Sean E, Gonzalez-Angulo Ana M, Huang Eugene H, Tucker Susan L, Kau Shu-Wan C, Yu Tse-Kuan, Strom Eric A, Oh Julia L, Woodward Wendy A, Tereffe Welela, Hunt Kelly K, Kuerer Henry M, Sahin Aysegul A, Hortobagyi Gabriel N, Buchholz Thomas A
Department of Radiation Oncology, The University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030, USA.
Int J Radiat Oncol Biol Phys. 2007 Jul 15;68(4):1004-9. doi: 10.1016/j.ijrobp.2007.01.023. Epub 2007 Apr 6.
The aim of this study was to investigate the role of postmastectomy radiation therapy in women with breast cancer who achieved a pathologic complete response (pCR) to neoadjuvant chemotherapy.
We retrospectively identified 226 patients treated at our institution who achieved a pCR at surgery after receiving neoadjuvant chemotherapy. Of these, the 106 patients without inflammatory breast cancer who were treated with mastectomy were analyzed. The patients' clinical stages at diagnosis were I in 2%, II in 31%, IIIA in 30%, IIIB in 25%, and IIIC in 11% (American Joint Committee on Cancer 2003 system). Of the patients, 92% received anthracycline-based chemotherapy, and 38% also received a taxane. A total of 72 patients received postmastectomy radiation therapy, and 34 did not. The actuarial rates of local-regional recurrence (LRR) and survival of the two groups were compared using the log-rank test.
The median follow-up of surviving patients was 62 months. Use of radiation therapy did not affect the 10-year rates of LRR for patients with Stage I or II disease (the 10-year LRR rates were 0% for both groups). However, the 10-year LRR rate for patients with Stage III disease was significantly improved with radiation therapy (7.3% +/- 3.5% with vs. 33.3% +/- 15.7% without; p = 0.040). Within this cohort, use of radiation therapy was also associated with improved disease-specific and overall survival.
Postmastectomy radiation therapy provides a significant clinical benefit for breast cancer patients who present with clinical Stage III disease and achieve a pCR after neoadjuvant chemotherapy.
本研究旨在探讨乳房切除术后放疗在对新辅助化疗达到病理完全缓解（pCR）的乳腺癌女性患者中的作用。
我们回顾性确定了在我院接受新辅助化疗后手术达到pCR的226例患者。其中，对106例接受乳房切除术且无炎性乳腺癌的患者进行了分析。患者诊断时的临床分期为：Ⅰ期占2%，Ⅱ期占31%，ⅢA期占30%，ⅢB期占25%，ⅡIC期占11%（美国癌症联合委员会2003年分期系统）。这些患者中，92%接受了以蒽环类为基础的化疗，38%还接受了紫杉烷类化疗。共有72例患者接受了乳房切除术后放疗，34例未接受。使用对数秩检验比较两组的局部区域复发（LRR）和生存的精算率。
存活患者的中位随访时间为62个月。放疗的使用对Ⅰ期或Ⅱ期疾病患者的10年LRR率没有影响（两组的10年LRR率均为0%）。然而，放疗显著提高了Ⅲ期疾病患者的10年LRR率（接受放疗组为7.3%±3.5%，未接受放疗组为33.3%±15.7%；p = 0.040）。在这个队列中，放疗的使用还与疾病特异性生存和总生存的改善相关。
乳房切除术后放疗对临床Ⅲ期疾病且新辅助化疗后达到pCR的乳腺癌患者具有显著的临床益处。
