Polgár Csaba, Fodor János, Major Tibor, Sulyok Zoltán, Kásler Miklós
Center of Radiotherapy, National Institute of Oncology, Budapest, Hungary.
Radiother Oncol. 2013 Aug;108(2):197-202. doi: 10.1016/j.radonc.2013.05.008. Epub 2013 Jun 3.
To report the long-term results of a single-institution randomized study comparing the results of breast-conserving treatment with partial breast irradiation (PBI) or conventional whole breast irradiation (WBI).
Between 1998 and 2004, 258 selected women with pT1 pN0-1mi M0, grade 1-2, non-lobular breast cancer without the presence of extensive intraductal component and resected with negative margins were randomized after BCS to receive 50 Gy WBI (n=130) or PBI (n=128). The latter consisted of either 7 × 5.2 Gy high-dose-rate (HDR) multi-catheter brachytherapy (BT; n=88) or 50 Gy electron beam (EB) irradiation (n=40). Primary endpoint was local recurrence (LR) as a first event. Secondary endpoints were overall survival (OS), cancer-specific survival (CSS), disease-free survival (DFS), and cosmetic results.
After a median follow up of 10.2 years, the ten-year actuarial rate of LR was 5.9% and 5.1% in PBI and WBI arms, respectively (p=0.77). There was no significant difference in the ten-year probability of OS (80% vs 82%), CSS (94% vs 92%), and DFS (85% vs 84%), either. The rate of excellent-good cosmetic result was 81% in the PBI, and 63% in the control group (p<0.01).
Partial breast irradiation delivered by interstitial HDR BT or EB for a selected group of early-stage breast cancer patients produces similar ten-year results to those achieved with conventional WBI. Significantly better cosmetic outcome can be achieved with HDR BT implants compared with the outcome after WBI.
报告一项单机构随机研究的长期结果，该研究比较了保乳治疗联合部分乳腺照射（PBI）或传统全乳照射（WBI）的结果。
1998年至2004年间，258例经选择的pT1 pN0-1mi M0、1-2级、非小叶型乳腺癌且无广泛导管内成分、切缘阴性的女性，在保乳手术后随机分为两组，分别接受50 Gy的WBI（n = 130）或PBI（n = 128）。后者包括7×5.2 Gy高剂量率（HDR）多导管近距离放疗（BT；n = 88）或50 Gy电子束（EB）照射（n = 40）。主要终点是作为首个事件的局部复发（LR）。次要终点是总生存（OS）、癌症特异性生存（CSS）、无病生存（DFS）和美容效果。
中位随访10.2年后，PBI组和WBI组的10年LR精算率分别为5.9%和5.1%（p = 0.77）。OS（80%对82%）、CSS（94%对92%）和DFS（85%对84%）的10年概率也无显著差异。PBI组的优-良美容效果率为81%，对照组为63%（p<0.01）。
对于选定的早期乳腺癌患者，通过组织间HDR BT或EB进行部分乳腺照射，其10年结果与传统WBI相似。与WBI后的结果相比，HDR BT植入可显著获得更好的美容效果。
