应用加速部分乳腺照射治疗浸润性小叶癌患者的临床结果。
Clinical outcomes using accelerated partial breast irradiation in patients with invasive lobular carcinoma.
机构信息
Department of Radiation Oncology, Beaumont Cancer Institute, Oakland University William Beaumont School of Medicine, Royal Oak, MI 48073, USA.
出版信息
Int J Radiat Oncol Biol Phys. 2011 Nov 15;81(4):e547-51. doi: 10.1016/j.ijrobp.2011.04.050. Epub 2011 Jun 2.
PURPOSE
We compared clinical outcomes of women diagnosed with either invasive lobular carcinoma (ILC) or invasive ductal carcinoma (IDC) treated with accelerated partial breast irradiation (APBI).
METHODS AND MATERIALS
A total of 16 patients with ILC received APBI as part of their breast-conservation therapy (BCT) and were compared with 410 patients with IDC that received APBI as part of their BCT. Clinical, pathologic, and treatment related variables were analyzed including age, tumor size, hormone receptor status, surgical margins, lymph node status, adjuvant hormonal therapy, adjuvant chemotherapy, and APBI modality. Clinical outcomes including local recurrence (LR), regional recurrence (RR), disease-free survival (DFS), cause-specific survival (CSS), and overall survival (OS) were analyzed.
RESULTS
Median follow-up was 3.8 years for the ILC patients and 6.0 years for the IDC patients. ILC patients were more likely to have positive margins (20.0% vs. 3.9%, p = 0.006), larger tumors (14.1 mm vs. 10.9 mm, p = 0.03) and less likely to be node positive (0% vs. 9.5%, p < 0.001) when compared with patients diagnosed with IDC. The 5-year rate of LR was 0% for the ILC cohort and 2.5% for the IDC cohort (p = 0.59). No differences were seen in the rates of RR (0% vs. 0.7%, p = 0.80), distant metastases (0% vs. 3.5%, p = 0.54), DFS (100% vs. 94%, p = 0.43), CSS (100% vs. 97%, p = 0.59), or OS (92% vs. 89%, p = 0.88) between the ILC and IDC patients, respectively. Additionally, when node-positive patients were excluded from the IDC cohort, no differences in the rates of LR (0% vs. 2.2%, p = 0.62), RR (0% vs. 0%), DFS (100% vs. 95%, p = 0.46), CSS (100% vs. 98%, p = 0.63), or OS (92% vs. 89%, p = 0.91) were noted between the ILC and IDC patients.
CONCLUSION
Women with ILC had excellent clinical outcomes after APBI. No difference in local control was seen between patients with invasive lobular versus invasive ductal histology.
目的
我们比较了接受加速部分乳房照射（APBI）治疗的浸润性小叶癌（ILC）和浸润性导管癌（IDC）患者的临床结局。
方法和材料
16 例 ILC 患者接受 APBI 作为保乳治疗（BCT）的一部分，并与 410 例 IDC 患者接受 APBI 作为 BCT 的一部分进行比较。分析了临床、病理和治疗相关变量，包括年龄、肿瘤大小、激素受体状态、手术切缘、淋巴结状态、辅助激素治疗、辅助化疗和 APBI 方式。分析了局部复发（LR）、区域复发（RR）、无病生存（DFS）、无特定原因生存（CSS）和总生存（OS）等临床结局。
结果
ILC 患者的中位随访时间为 3.8 年，IDC 患者的中位随访时间为 6.0 年。与 IDC 患者相比，ILC 患者更有可能出现阳性切缘（20.0% vs. 3.9%，p=0.006）、更大的肿瘤（14.1mm vs. 10.9mm，p=0.03）和更少的淋巴结阳性（0% vs. 9.5%，p<0.001）。ILC 组的 5 年 LR 率为 0%，IDC 组为 2.5%（p=0.59）。RR 率（0% vs. 0.7%，p=0.80）、远处转移率（0% vs. 3.5%，p=0.54）、DFS 率（100% vs. 94%，p=0.43）、CSS 率（100% vs. 97%，p=0.59）和 OS 率（92% vs. 89%，p=0.88）在 ILC 和 IDC 患者之间均无差异。此外，当排除 IDC 队列中的淋巴结阳性患者时，LR 率（0% vs. 2.2%，p=0.62）、RR 率（0% vs. 0%）、DFS 率（100% vs. 95%，p=0.46）、CSS 率（100% vs. 98%，p=0.63）和 OS 率（92% vs. 89%，p=0.91）在 ILC 和 IDC 患者之间均无差异。
结论
接受 APBI 治疗的 ILC 患者临床结局良好。浸润性小叶癌与浸润性导管癌患者的局部控制率无差异。
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