Wright Jean L, Cordeiro Peter G, Ben-Porat Leah, Van Zee Kimberly J, Hudis Clifford, Beal Kathryn, McCormick Beryl
Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA.
Int J Radiat Oncol Biol Phys. 2008 Jan 1;70(1):43-50. doi: 10.1016/j.ijrobp.2007.05.032. Epub 2007 Sep 12.
To determine intervals between surgery and adjuvant chemotherapy and radiation in patients treated with mastectomy with immediate expander-implant reconstruction, and to evaluate locoregional and distant control and overall survival in these patients.
Between May 1996 and March 2004, 104 patients with Stage II-III breast cancer were routinely treated at our institution under the following algorithm: (1) definitive mastectomy with axillary lymph node dissection and immediate tissue expander placement, (2) tissue expansion during chemotherapy, (3) exchange of tissue expander for permanent implant, (4) radiation. Patient, disease, and treatment characteristics and clinical outcomes were retrospectively evaluated.
Median age was 45 years. Twenty-six percent of patients were Stage II and 74% Stage III. All received adjuvant chemotherapy. Estrogen receptor staining was positive in 77%, and 78% received hormone therapy. Radiation was delivered to the chest wall with daily 0.5-cm bolus and to the supraclavicular fossa. Median dose was 5,040 cGy. Median interval from surgery to chemotherapy was 5 weeks, from completion of chemotherapy to exchange 4 weeks, and from exchange to radiation 4 weeks. Median interval from completion of chemotherapy to start of radiation was 8 weeks. Median follow-up was 64 months from date of mastectomy. The 5-year rate for locoregional disease control was 100%, for distant metastasis-free survival 90%, and for overall survival 96%.
Mastectomy with immediate expander-implant reconstruction, adjuvant chemotherapy, and radiation results in a median interval of 8 weeks from completion of chemotherapy to initiation of radiation and seems to be associated with acceptable 5-year locoregional control, distant metastasis-free survival, and overall survival.
确定接受乳房切除术并即刻置入扩张器-植入物重建的患者手术与辅助化疗及放疗之间的间隔时间，并评估这些患者的局部区域和远处控制情况以及总生存率。
1996年5月至2004年3月期间，104例II-III期乳腺癌患者在我们机构按照以下方案进行常规治疗：(1) 行根治性乳房切除术及腋窝淋巴结清扫，并即刻置入组织扩张器；(2) 在化疗期间进行组织扩张；(3) 将组织扩张器更换为永久性植入物；(4) 放疗。对患者、疾病、治疗特征及临床结果进行回顾性评估。
中位年龄为45岁。26%的患者为II期，74%为III期。所有患者均接受辅助化疗。雌激素受体染色阳性率为77%，78%的患者接受激素治疗。对胸壁进行放疗时每日给予0.5厘米的填充物，对锁骨上窝也进行放疗。中位剂量为5040厘戈瑞。从手术到化疗的中位间隔时间为5周，从化疗结束到更换的间隔时间为4周，从更换到放疗的间隔时间为4周。从化疗结束到开始放疗的中位间隔时间为8周。自乳房切除之日起的中位随访时间为64个月。局部区域疾病控制的5年率为100%，无远处转移生存率为90%，总生存率为96%。
乳房切除术并即刻置入扩张器-植入物重建、辅助化疗及放疗导致从化疗结束到开始放疗的中位间隔时间为8周，且似乎与可接受的5年局部区域控制、无远处转移生存率及总生存率相关。
