Bräutigam Elisabeth, Track Christine, Seewald Dietmar H, Feichtinger Johann, Spiegl Kurt, Hammer Josef
Department of Radiation Oncology, Barmherzige Schwestern Hospital, Linz, Austria.
Strahlenther Onkol. 2009 Oct;185(10):663-8. doi: 10.1007/s00066-009-1984-x. Epub 2009 Oct 6.
To demonstrate the unfavorable results in survival rates in patients with medial breast cancer compared to patients with laterally located tumors of the mammary gland.
Between 1984 and 1995, 1,089 patients presenting with a total of 1,100 pT1-2 invasive carcinomas of the breast were treated at the authors' institution. 707 presented with tumors in the lateral quadrants, 294 with tumors in the medial quadrants, and 99 with tumors in the central quadrant. Treatment protocols involved breast-conserving surgery and whole-breast radiotherapy in all women, followed by a tumor bed boost dose according to risk factors for local recurrence. All axillary node-positive patients underwent systemic therapy (six cycles of classic CMF and/or 2-5 years of tamoxifen 20 mg/day). Rates of actuarial survival and local control were calculated by the Kaplan-Meier method and differences in survival curves were compared by use of the log-rank test.
The mean follow-up of survivors was 97 months (range 36-192 months). Comparing patients with medial and lateral tumors, the actuarial survival data were significantly better for patients with lateral tumors. At 10 years, overall survival for patients with medial tumors was 71%, for patients with lateral tumors 81.8% (p < 0.025), disease-specific survival for patients with medial tumors 79.9%, for patients with lateral tumors 89.1% (p < 0.025). There was no significant difference in local tumor control according to tumor location.
Medial tumor location is associated with a lower survival rate, but not with inferior local tumor control. Failure to identify nodal metastases confined to the internal mammary chain may lead to undertreatment with systemic/local agents and compromised survival.
证明与乳腺外侧肿瘤患者相比，乳腺内侧癌患者的生存率结果不佳。
1984年至1995年间，作者所在机构共治疗了1089例患有1100例pT1 - 2期乳腺浸润性癌的患者。707例患者肿瘤位于外侧象限，294例患者肿瘤位于内侧象限，99例患者肿瘤位于中央象限。治疗方案包括所有女性均接受保乳手术和全乳放疗，随后根据局部复发风险因素给予瘤床追加剂量放疗。所有腋窝淋巴结阳性患者均接受全身治疗（经典CMF方案六个周期和/或每天20毫克他莫昔芬治疗2 - 5年）。采用Kaplan - Meier法计算精算生存率和局部控制率，并使用对数秩检验比较生存曲线的差异。
幸存者的平均随访时间为97个月（范围36 - 192个月）。比较内侧和外侧肿瘤患者，外侧肿瘤患者的精算生存数据明显更好。10年时，内侧肿瘤患者的总生存率为71%，外侧肿瘤患者为81.8%（p < 0.025）；内侧肿瘤患者的疾病特异性生存率为79.9%，外侧肿瘤患者为89.1%（p < 0.025）。根据肿瘤位置，局部肿瘤控制方面无显著差异。
肿瘤位于内侧与较低的生存率相关，但与局部肿瘤控制不佳无关。未能识别局限于内乳链的淋巴结转移可能导致全身/局部治疗不足并影响生存率。
