Radiation Therapy Program, British Columbia Cancer Agency, Vancouver Island Center, Victoria, British Columbia, Canada.
Cancer. 2011 Jan 1;117(1):54-62. doi: 10.1002/cncr.25344. Epub 2010 Aug 27.
Boost radiotherapy (RT) improves outcomes for patients with invasive breast cancer, but whether this is applicable to patients with pure ductal carcinoma in situ (DCIS) is unclear. This study examined outcomes from whole breast RT, with or without a boost, and the impact of different dose-fractionation schedules in a population-based cohort of women with pure DCIS treated with breast-conserving surgery (BCS).
Data was analyzed for 957 subjects diagnosed between 1985 and 1999. RT use was analyzed over time. Ten-year Kaplan-Meier local control (LC), breast cancer specific survival (BCSS), and overall survival (OS) were compared using the log-rank test. Cox regression modeling of LC was performed.
Median follow-up was 9.3 years. Of the patient cohort 475 (50%) had no RT (NoRT) after BCS, 338 (35%) had RT without a partial breast boost (RTNoB), and 144 (15%) had RT with boost (RT + B). Subjects with risk factors of local recurrence were more likely to receive RT. Subjects receiving adjuvant RT had a trend toward improved LC (15-year LC: NoRT 87%; RTNoB 94%; RT + B 91%; P = .065). Multivariable analysis showed that RT with or without a boost was significantly associated with improved LC (HR, 0.29 and 0.38, respectively, compared with NoRT, P = .025), with no difference associated with a boost or different dose-fractionation schedules.
Adjuvant RT improves local control in patients with DCIS treated with BCS. Hypofractionation is as effective as standard fractionation schedules. Boost RT was not associated with improved LC compared with whole breast RT alone. Cancer 2011. © 2010 American Cancer Society.
提高放射治疗（RT）可改善浸润性乳腺癌患者的预后，但对于单纯导管原位癌（DCIS）患者是否适用尚不清楚。本研究通过回顾性分析，在接受保乳手术（BCS）的单纯 DCIS 患者的人群中，观察全乳 RT 及加量放疗的疗效，以及不同剂量分割方案的影响。
分析了 1985 年至 1999 年间诊断为 957 例患者的数据。分析 RT 应用的时间趋势。采用对数秩检验比较 10 年的局部控制（LC）、乳腺癌特异性生存（BCSS）和总生存（OS）的 Kaplan-Meier 曲线。对 LC 进行 Cox 回归建模。
中位随访时间为 9.3 年。在患者队列中，475 例（50%）在 BCS 后未接受放疗（NoRT），338 例（35%）接受了全乳放疗但未加量（RTNoB），144 例（15%）接受了全乳加量放疗（RT + B）。有局部复发危险因素的患者更倾向于接受 RT。接受辅助 RT 的患者 LC 有改善趋势（15 年 LC：NoRT 为 87%，RTNoB 为 94%，RT + B 为 91%，P =.065）。多变量分析显示，加量或不加量 RT 与 LC 改善显著相关（与 NoRT 相比，HR 分别为 0.29 和 0.38，P =.025），与加量或不同剂量分割方案无关。
辅助 RT 可改善接受 BCS 的 DCIS 患者的局部控制。与标准分割方案相比，Hypofractionation 同样有效。与单纯全乳 RT 相比，加量 RT 并未改善 LC。癌症 2011。© 2010 美国癌症协会。
