Gasparini G, Panizzoni G A, Dal Fior S, Germani B, Dall'Antonia F, Segato G, Meli S, Pozza F
St. Bortolo Regional Hospital, Vicenza, Italy.
Anticancer Res. 1991 Jul-Aug;11(4):1635-40.
From 1980 to 1987, 243 evaluable patients with pT1, pT2 (less than 3 centimeters in diameter), N0, M0, invasive breast cancer were treated with "quadrantectomy" with axillary dissection followed by electron beam radiation therapy (QUART) at the St. Bortolo Hospital, Vicenza. Stage II patients received adjuvant chemotherapy (CMF) if preperimenopausal or hormonotherapy (tamoxifen) if postmenopausal. The median follow-up was 54 months (26 to 116 months). The 4.5-year overall survival (OS) and disease-free survival (DFS) were respectively 91% and 85%; the 10-year actuarially estimated OS and DFS was 77%. Thirty-three patients relapsed, 11 of whom had local recurrence, and 23 developed distant metastases. A significantly longer OS and DFS were observed in stage I versus stage II (p = 0.0008) and in pT1 versus pT2 (p = 0.001) tumors. No difference was found regarding menopausal status and histotype. The local control of disease was very high (95.5%), with a significantly higher local recurrence rate in premenopausal women compared to postmenopausal (10/117 versus 1/126; p = 0.009). Tumor size did not influence the frequency of local recurrence. No major complications occurred but a significantly higher rate of reversible radiation-pneumonitis occurred in patients treated with higher energies of electrons (17 to 20 MeV) compared with lower (6 to 13 MeV) (33/177 versus 7/66; p less than 0.05). Cosmetic results were judged as excellent in 20%, satisfactory in 68%, unsatisfactory in 6% and not evaluable in 6% of cases. We conclude first, that small pT2 breast carcinomas may also be safely treated with QUART, second, that the electron beam is a radiotherapeutic technique able to produce a good cosmetic result and to assure a satisfactory local control and, finally, that the use of tamoxifen in postmenopausal stage II breast carcinomas is safe and easy to combine with radiotherapy in the conservative management of early breast cancer due to the lower toxic effects, compared to those observed in premenopausal women treated with chemotherapy.
1980年至1987年期间，243例可评估的pT1、pT2（直径小于3厘米）、N0、M0期浸润性乳腺癌患者在维琴察圣博托洛医院接受了“象限切除术”加腋窝清扫术，随后进行电子束放射治疗（QUART）。II期患者如果是绝经前则接受辅助化疗（CMF），如果是绝经后则接受激素治疗（他莫昔芬）。中位随访时间为54个月（26至116个月）。4.5年的总生存率（OS）和无病生存率（DFS）分别为91%和85%；10年精算估计的OS和DFS为77%。33例患者复发，其中11例出现局部复发，23例发生远处转移。I期与II期（p = 0.0008）以及pT1与pT2（p = 0.001）肿瘤相比，观察到OS和DFS显著更长。在绝经状态和组织学类型方面未发现差异。疾病的局部控制率非常高（95.5%），绝经前女性的局部复发率显著高于绝经后女性（10/117对1/126；p = 0.009）。肿瘤大小不影响局部复发频率。未发生重大并发症，但与较低能量电子（6至13 MeV）治疗的患者相比，较高能量电子（17至20 MeV）治疗的患者发生可逆性放射性肺炎的比例显著更高（33/177对7/66；p＜0.05）。20%的病例美容效果评为优秀，68%为满意，6%为不满意，6%无法评估。我们首先得出结论，小的pT2期乳腺癌也可以安全地用QUART治疗；其次，电子束是一种能够产生良好美容效果并确保令人满意的局部控制的放射治疗技术；最后，在绝经后II期乳腺癌中使用他莫昔芬是安全的，并且由于其毒性作用低于绝经前接受化疗的女性，因此在早期乳腺癌的保守治疗中很容易与放疗联合使用。
