Moffat F L, Ketcham A S, Robinson D S, Legaspi A, Ghandur-Mnaymneh L, Hilsenbeck S
Department of Surgery, University of Miami, Fla.
Arch Surg. 1990 Mar;125(3):364-9. doi: 10.1001/archsurg.1990.01410150086016.
We describe 111 patients with invasive breast cancer treated by segmental mastectomy at the University of Miami (Fla) since 1975. Postoperative adjuvant radiotherapy was recommended as optional rather than mandatory to 64 of these patients based on small (2.5 cm or less) primary tumor size, adequate resection margins, no lymphatic or vascular invasion within the segmental mastectomy specimen, and minimal associated in situ cancer. Fifty-one of these patients elected to forego postoperative adjuvant radiotherapy. At 72 months median follow-up, relapse occurred in the ipsilateral breast in three patients who elected to forego postoperative adjuvant radiotherapy (6% by Kaplan-Meier analysis). Retrospective pathologic review revealed that tumor grade may also be important in determining whether postoperative adjuvant radiotherapy is necessary following segmental mastectomy. These data suggest that postoperative adjuvant radiotherapy may not be required in every patient treated by segmental mastectomy. Further studies to define which patients can be spared the inconvenience, expense, and potential morbidity of postoperative adjuvant radiotherapy are warranted.
我们描述了自1975年以来在迈阿密大学（佛罗里达州）接受乳房部分切除术治疗的111例浸润性乳腺癌患者。基于原发肿瘤较小（2.5厘米或更小）、切缘充分、乳房部分切除标本内无淋巴管或血管侵犯以及相关原位癌极少，对其中64例患者建议术后辅助放疗为可选而非强制治疗。这些患者中有51例选择放弃术后辅助放疗。在中位随访72个月时，选择放弃术后辅助放疗的3例患者在同侧乳房出现复发（根据Kaplan-Meier分析为6%）。回顾性病理检查显示，肿瘤分级在确定乳房部分切除术后是否需要术后辅助放疗方面可能也很重要。这些数据表明，并非每个接受乳房部分切除术治疗的患者都需要术后辅助放疗。有必要进行进一步研究，以确定哪些患者可以避免术后辅助放疗带来的不便、费用和潜在发病率。
