局部乳房放疗后行前哨淋巴结活检或腋窝清扫术的腋窝淋巴结阴性患者 10 年后的并发症发生率。
Complication rates in patients with negative axillary nodes 10 years after local breast radiotherapy after either sentinel lymph node dissection or axillary clearance.
机构信息
Department of Radiation Oncology, Weill Cornell Medical College of Cornell University, New York, NY 10065, USA.
出版信息
Am J Clin Oncol. 2013 Feb;36(1):12-9. doi: 10.1097/COC.0b013e3182354bda.
BACKGROUND
We assess complication rates in node negative breast cancer patients treated with breast radiotherapy (RT) only after sentinel lymph node dissection (SLND) or axillary lymph node dissection (ALND).
MATERIALS AND METHODS
Between 1995 and 2001, 226 women with AJCC stage I-II breast cancer were treated with lumpectomy, either SLND or SLND+ALND, and had available toxicities in follow-up: 111/136 (82%) and 115/129 (89%) in SLND and ALND groups, respectively. RT targeted the breast to median dose of 48.2 Gy (range, 46.0 to 50.4 Gy) without axillary RT. Chi-square tests compared complication rates of 2 groups for axillary web syndrome (AWS), seroma, wound infection, decreased range of motion of the ipsilateral shoulder, paresthesia, and lymphedema.
RESULTS
Median follow-up was 9.9 years (range, 8.3-15.3 y). Median number of nodes assessed was 2 (range, 1-5) in SLND and 18 (range, 7-36) in ALND (P < 0.0001). Acute complications occurred during the first 2 years and were AWS, seroma, and wound infection. Incidences of seroma 5/111 (4.5%) in SLND and 16/115 (13.9%) in ALND (P < 0.02, respectively) and wound infection 3/111 (2.7%) in SLND and 10/115 (8.7%) in ALND (P < 0.05, respectively) differed significantly. AWS was not statistically different between the groups. At 10 years, the only chronic complications decreased were range of motion of the shoulder 46/111 (41.4%) in SLND and 92/115 (80.0%) in ALND (P < 0.0001), paresthesia 12/111 (10.8%) in SLND and 39/115 (33.9%) in ALND (P < 0.0001), and lymphedema assessed by patients 10/111 (10.0%) in SLND and 39/115 (33.9%) in ALND (P < 0.0001). Chronic lymphedema, assessed by clinicians, occurred in 6/111 (5.4%) in SLND and 21/115 (18.3%) in ALND cohorts, respectively (P < 0.0001).
CONCLUSIONS
Our mature findings support that in patients with negative axillary nodal status SLND and breast RT provide excellent long-term cure rates while avoiding morbidities associated with ALND or addition of axillary RT field.
背景
我们评估了在接受前哨淋巴结活检（SLND）或腋窝淋巴结清扫（ALND）后仅接受乳房放疗（RT）的淋巴结阴性乳腺癌患者的并发症发生率。
材料与方法
1995 年至 2001 年间，226 例 AJCC Ⅰ-Ⅱ期乳腺癌患者接受保乳手术，其中 136 例接受 SLND，129 例接受 SLND+ALND，随访中可评估毒性：SLND 和 ALND 组分别为 111/136（82%）和 115/129（89%）。RT 针对乳房，中位剂量为 48.2 Gy（范围 46.0 至 50.4 Gy），不包括腋窝 RT。卡方检验比较两组间的并发症发生率，包括腋窝网综合征（AWS）、血清肿、伤口感染、同侧肩部活动范围减小、感觉异常和淋巴水肿。
结果
中位随访时间为 9.9 年（范围 8.3-15.3 年）。SLND 组评估的中位淋巴结数为 2（范围 1-5），ALND 组为 18（范围 7-36）（P<0.0001）。急性并发症发生在最初 2 年内，包括 AWS、血清肿和伤口感染。SLND 组血清肿发生率为 5/111（4.5%），ALND 组为 16/115（13.9%）（P<0.02），伤口感染发生率为 SLND 组 3/111（2.7%），ALND 组为 10/115（8.7%）（P<0.05），差异有统计学意义。AWS 在两组间无统计学差异。10 年时，仅肩部活动范围减小的慢性并发症降低，SLND 组为 46/111（41.4%），ALND 组为 92/115（80.0%）（P<0.0001），感觉异常 SLND 组为 12/111（10.8%），ALND 组为 39/115（33.9%）（P<0.0001），患者评估的淋巴水肿 SLND 组为 10/111（10.0%），ALND 组为 39/115（33.9%）（P<0.0001）。SLND 组慢性淋巴水肿的发生率为 6/111（5.4%），ALND 组为 21/115（18.3%）（P<0.0001）。
结论
我们成熟的研究结果支持，在腋窝淋巴结阴性的患者中，SLND 和乳房 RT 提供了优异的长期治愈率，同时避免了 ALND 或腋窝 RT 区域增加相关的发病率。
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