Harvard Radiation Oncology Program, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
Int J Radiat Oncol Biol Phys. 2010 May 1;77(1):188-96. doi: 10.1016/j.ijrobp.2009.04.059. Epub 2010 Feb 18.
To evaluate the risk of isolated regional nodal failure (RNF) among women with invasive breast cancer treated with breast-conserving surgery (BCS) and radiation therapy (RT) and to determine factors, including biological subtype, associated with RNF.
We retrospectively studied 1,000 consecutive women with invasive breast cancer who received breast-conserving surgery and RT from 1997 through 2002. Ninety percent of patients received adjuvant systemic therapy; none received trastuzumab. Sentinel lymph node biopsy was done in 617 patients (62%). Of patients with one to three positive nodes, 34% received regional nodal irradiation (RNI). Biological subtype classification into luminal A, luminal B, HER-2, and basal subtypes was based on estrogen receptor status-, progesterone receptor status-, and HER-2-status of the primary tumor.
Median follow-up was 77 months. Isolated RNF occurred in 6 patients (0.6%). On univariate analysis, biological subtype (p = 0.0002), lymph node involvement (p = 0.008), lymphovascular invasion (p = 0.02), and Grade 3 histology (p = 0.01) were associated with significantly higher RNF rates. Compared with luminal A, the HER-2 (p = 0.01) and basal (p = 0.08) subtypes were associated with higher RNF rates. The 5-year RNF rate among patients with one to three positive nodes treated with tangents alone was 2.4%; we could not identify a subset of these patients with a substantial risk of RNF.
Isolated RNF is a rare occurrence after breast-conserving therapy. Patients with the HER-2 (not treated with trastuzumab) and basal subtypes appear to be at higher risk of developing RNF although this risk is not high enough to justify the addition of RNI. Low rates of RNF in patients with one to three positive nodes suggest that tangential RT without RNI is reasonable in most patients.
评估接受保乳手术（BCS）和放射治疗（RT）治疗的浸润性乳腺癌女性中孤立区域性淋巴结失败（RNF）的风险，并确定与 RNF 相关的因素，包括生物学亚型。
我们回顾性研究了 1000 例 1997 年至 2002 年间接受 BCS 和 RT 的浸润性乳腺癌连续患者。90%的患者接受了辅助全身治疗；没有接受曲妥珠单抗治疗。617 例患者（62%）进行了前哨淋巴结活检。对于 1 至 3 个阳性淋巴结的患者，34%接受了区域淋巴结照射（RNI）。基于原发肿瘤的雌激素受体状态、孕激素受体状态和 HER-2 状态，将生物学亚型分类为 luminal A、luminal B、HER-2 和基底亚型。
中位随访时间为 77 个月。6 例患者（0.6%）发生孤立性 RNF。单因素分析显示，生物学亚型（p = 0.0002）、淋巴结受累（p = 0.008）、淋巴血管侵犯（p = 0.02）和 3 级组织学（p = 0.01）与更高的 RNF 率显著相关。与 luminal A 相比，HER-2（p = 0.01）和基底（p = 0.08）亚型与更高的 RNF 率相关。接受单纯切线照射的 1 至 3 个阳性淋巴结患者的 5 年 RNF 率为 2.4%；我们无法确定这些患者中有相当一部分存在 RNF 的高风险。
保乳治疗后孤立性 RNF 很少发生。尽管风险不足以证明添加 RNI，但接受曲妥珠单抗治疗的 HER-2（未接受曲妥珠单抗治疗）和基底亚型患者似乎有更高的 RNF 风险。1 至 3 个阳性淋巴结患者的 RNF 发生率低表明，大多数患者接受切线 RT 而不接受 RNI 是合理的。
