Department of Radiation Oncology, Yonsei University College of Medicine, Seoul, Republic of Korea.
Int J Radiat Oncol Biol Phys. 2013 Aug 1;86(5):867-72. doi: 10.1016/j.ijrobp.2013.02.037. Epub 2013 Jun 6.
To examine the effect of internal mammary node irradiation (IMNI) on disease-free survival (DFS) and overall survival (OS) in breast cancer patients treated with modified radical mastectomy and postoperative radiation therapy.
Between 1994 and 2002, 396 patients with stage II-III breast cancer were treated with postmastectomy radiation therapy with (n=197) or without (n=199) IMNI. Patients who received neoadjuvant chemotherapy were excluded. IMNI was administered at the clinical discretion of the treating physician. Median RT dose was 50.4 Gy (range, 45.0-59.4 Gy) in 28 fractions, with inclusion of the supraclavicular fossa in 96% of patients. Adjuvant chemotherapy was administered to 99.7% of the patients and endocrine therapy to 53%.
The median follow-up was 149 months (range, 124-202). IMNI patients had more advanced nodal stage and non-high grade tumors than those without IMNI (P<.001). Otherwise, disease and treatment characteristics were well balanced. The 10-year DFS with and without IMNI was 65% and 57%, respectively (P=.05). Multivariate analysis demonstrated that IMNI was an independent, positive predictor of DFS (hazard ratio [HR], 0.70; P=.02). Benefits of IMNI in DFS were seen most apparently in N2 patients (HR, 0.44; 95% confidence interval [CI], 0.26-0.74) and inner/central tumors (HR, 0.55; 95% CI, 0.34-0.90). The 10-year OS with and without IMNI was 72% and 66%, respectively (P=.62). The 10-year DFS and OS were 61%, and 69%, respectively.
Internal mammary node irradiation significantly improved DFS in postmastectomy breast cancer patients. Pending long-term results from randomized trials, treatment of internal mammary nodes should be considered in postmastectomy radiation therapy.
研究乳腺癌改良根治术后接受放射治疗的患者中，内乳淋巴结照射（IMNI）对无病生存（DFS）和总生存（OS）的影响。
1994 年至 2002 年间，396 例 II 期-III 期乳腺癌患者接受了术后放射治疗，其中 197 例（IMNI 组）和 199 例（无 IMNI 组）接受了 IMNI。排除接受新辅助化疗的患者。IMNI 由治疗医生根据临床判断进行。96%的患者接受了中位剂量为 50.4 Gy（范围，45.0-59.4 Gy）的 28 分次放疗，锁骨上野均包括在内。99.7%的患者接受了辅助化疗，53%的患者接受了内分泌治疗。
中位随访时间为 149 个月（范围，124-202）。与无 IMNI 组相比，IMNI 组患者的淋巴结分期更晚，肿瘤非高分级（P<.001）。否则，疾病和治疗特征均衡。有和无 IMNI 的 10 年 DFS 分别为 65%和 57%（P=.05）。多因素分析显示，IMNI 是 DFS 的独立、正向预测因素（风险比[HR]，0.70；P=.02）。IMNI 在 DFS 中的获益在 N2 患者（HR，0.44；95%置信区间[CI]，0.26-0.74）和内/中央肿瘤患者（HR，0.55；95%CI，0.34-0.90）中最为明显。有和无 IMNI 的 10 年 OS 分别为 72%和 66%（P=.62）。10 年 DFS 和 OS 分别为 61%和 69%。
内乳淋巴结照射显著改善了乳腺癌改良根治术后患者的 DFS。在随机试验的长期结果出来之前，内乳淋巴结的治疗应考虑在乳腺癌根治术后的放射治疗中。
