Department of Radiation Oncology, Stich Radiation Oncology, Weil Cornell Medical College of Cornell University, 525 East 68th Street, New York, NY 10065, USA.
Breast Cancer Res Treat. 2011 Feb;125(3):893-902. doi: 10.1007/s10549-010-1167-6. Epub 2010 Sep 19.
We compare long-term outcomes in patients with node negative early stage breast cancer treated with breast radiotherapy (RT) without the axillary RT field after sentinel lymph node dissection (SLND) or axillary lymph node dissection (ALND). We hypothesize that though tangential RT was delivered to the breast tissue, it at least partially sterilized occult axillary nodal metastases thus providing low nodal failure rates. Between 1995 and 2001, 265 patients with AJCC stages I-II breast cancer were treated with lumpectomy and either SLND (cohort SLND) or SLND and ALND (cohort ALND). Median follow-up was 9.9 years (range 8.3-15.3 years). RT was administered to the whole breast to the median dose of 48.2 Gy (range 46.0-50.4 Gy) plus boost without axillary RT. Chi-square tests were employed in comparing outcomes of two groups for axillary and supraclavicular failure rates, ipsilateral in-breast tumor recurrence (IBTR), distant metastases (DM), and chronic complications. Progression-free survival (PFS) was compared using log-rank test. There were 136/265 (51%) and 129/265 (49%) patients in the SLND and ALND cohorts, respectively. The median number of axillary lymph nodes assessed was 2 (range 1-5) in cohort SLND and 18 (range 7-36) in cohort ALND (P < 0.0001). Incidence of AFR and SFR in both cohorts was 0%. The rates of IBTR and DM in both cohorts were not significantly different. Median PFS in the SLND cohort is 14.6 years and 10-year PFS is 88.2%. Median PFS in the ALND group is 15.0 years and 10-year PFS is 85.7%. At a 10-year follow-up chronic lymphedema occurred in 5/108 (4.6%) and 40/115 (34.8%) in cohorts SLND and ALND, respectively (P = 0.0001). This study provides mature evidence that patients with negative nodes, treated with tangential breast RT and SLND alone, experience low AFR or SFR. Our findings, while awaiting mature long-term data from NSABP B-32, support that in patients with negative axillary nodal status such treatment provides excellent long-term cure rates while avoiding morbidities associated with ALND or addition of axillary RT field.
我们比较了接受保乳手术后，接受前哨淋巴结活检（SLND）或腋窝淋巴结清扫（ALND）的淋巴结阴性早期乳腺癌患者的长期结果。我们假设，尽管对乳房组织进行了切线放疗，但它至少部分地消灭了隐匿性腋窝淋巴结转移，从而提供了较低的淋巴结失败率。1995 年至 2001 年间，265 例 AJCC 分期 I-II 期乳腺癌患者接受了保乳手术，分别接受了 SLND（SLND 组）或 SLND 和 ALND（ALND 组）。中位随访时间为 9.9 年（8.3-15.3 年）。对整个乳房进行放疗，中位剂量为 48.2 Gy（范围 46.0-50.4 Gy），加用无腋窝放疗的推量。采用卡方检验比较两组腋窝和锁骨上失败率、同侧乳房内肿瘤复发（IBTR）、远处转移（DM）和慢性并发症的结果。采用对数秩检验比较无进展生存（PFS）。SLND 组和 ALND 组分别有 136/265（51%）和 129/265（49%）例患者。SLND 组中评估的腋窝淋巴结中位数为 2 个（范围 1-5），ALND 组为 18 个（范围 7-36）（P<0.0001）。两组的 AFR 和 SFR 发生率均为 0%。两组的 IBTR 和 DM 发生率无显著差异。SLND 组的中位 PFS 为 14.6 年，10 年 PFS 为 88.2%。ALND 组的中位 PFS 为 15.0 年，10 年 PFS 为 85.7%。在 10 年随访时，SLND 组有 5/108（4.6%）例和 ALND 组有 40/115（34.8%）例发生慢性淋巴水肿（P=0.0001）。这项研究提供了成熟的证据，表明接受切线乳房放疗和单独 SLND 治疗的淋巴结阴性患者，发生 AFR 或 SFR 的风险较低。我们的研究结果在等待 NSABP B-32 的成熟长期数据的同时，支持在腋窝淋巴结状态阴性的患者中，这种治疗提供了极好的长期治愈率，同时避免了与 ALND 或腋窝放疗区域增加相关的发病率。
