Montbarbon X, Ardiet J M, Chassard J L, Gerard J P, Lacroze M, Romestaing P, Mornex F, Carrie C, Dutou L, Montbarbon J F
Département de radiothérapie, Centre Léon-Bérard, Lyon, France.
Bull Cancer. 1990;77(9):917-23.
Over a 20-year period (1969-1983), 570 infiltrating primary breast carcinomas were conservatively treated in Lyons. Two different protocols were used: a first group of 162 patients with T1 T2 less than 3 cm NO lesions was treated, between 1963 and 1973, by lumpectomy and external beam irradiation with 60cobalt. The 5 and 10 year overall survival rates are 86% and 66% respectively. Local and regional failure rates are 10% and 2.5%. Cosmetic result was good or excellent in 70% of patients with only 5% poor results; a second group of 408 patients with T1 T2 less than 3 cm lesions was treated between 1973 and 1983 by tumorectomy and axillary dissection, followed by cobalt irradiation and 192iridium boost. The 5-year overall survival rate was 90% and, at 5 years, the probability of failure is 5% in the breast and 2% in the axilla. Cosmetic results are comparable in the 2 groups. Comparison of these 2 groups indicates an improvement in local control with Iridium boost. No obvious change in axillary recurrence rate and overall survival rate was observed. Boost modalities are discussed, with regard to cosmetic results. A prospective randomized study was initiated in 1986, in order to assess the value of the boost in the conservative treatment of breast cancer.
在20年期间（1969 - 1983年），里昂对570例浸润性原发性乳腺癌进行了保守治疗。采用了两种不同的方案：第一组162例T1、T2小于3 cm且无淋巴结转移（NO）的患者，在1963年至1973年间接受了肿块切除术和60钴外照射治疗。5年和10年总生存率分别为86%和66%。局部和区域失败率分别为10%和2.5%。70%的患者美容效果良好或极佳，只有5%的效果较差；第二组408例T1、T2小于3 cm的患者，在1973年至1983年间接受了肿瘤切除术和腋窝淋巴结清扫术，随后进行钴照射和192铱增强照射。5年总生存率为90%，5年后，乳房失败概率为5%，腋窝为2%。两组的美容效果相当。这两组的比较表明，铱增强照射可改善局部控制。腋窝复发率和总生存率未观察到明显变化。讨论了增强照射方式对美容效果的影响。1986年启动了一项前瞻性随机研究，以评估增强照射在乳腺癌保守治疗中的价值。
