Aleknavičius Eduardas, Atkočius Vydmantas, Kuzmickienė Irena, Steponavičienė Rita
Radiotherapy and Drug Therapy Centre, National Cancer Institute, Vilnius, Lithuania.
Scientific Research Centre, National Cancer Institute, Vilnius, Lithuania.
Medicina (Kaunas). 2014;50(4):230-6. doi: 10.1016/j.medici.2014.09.010. Epub 2014 Oct 7.
The internal mammary lymph nodes (IMN) have been recognized as a potential site of regional breast cancer spread. The aim of this study was to evaluate the impact of internal mammary node radiotherapy (RT) to on clinical outcomes in breast cancer patients treated with mastectomy and postoperative radiation therapy.
This cohort study included 588 patients with breast cancers located in the central and medial quadrants. IMN RT was applied to 320 patients and 268 patients did not receive it IMN RT. Inside the IMN RT group, 165 patients received external beam IMN irradiation (IMN-EB). Mastectomy combined with using Californium-252 neutron source implantation was applied to 155 patients (IMN-BT). Cox proportional hazards modeling was used to determine the influence of IMN RT on clinical outcome. Age, tumor size, lymph nodal status, adjuvant radiotherapy, chemotherapy and hormonal therapy were assessed.
IMN-EB resulted in a significant improvement of distant metastasis-free survival, breast cancer-specific survival and overall survival (P=0.033, P=0.037 and P=0.011, respectively). The IMN-EB radiotherapy has a significant impact on event-free survival (HR, 0.67; 95% CI, 0.46-0.91; P=0.043) and breast cancer-specific survival (HR, 0.64; 95% CI, 45-0.91; P=0.013) in patients with moderate-risk (stage T1-2N1). There was no association between IMN RT and clinical outcomes of patients with high-risk disease (stage T3-4N2-3) in any of the study end points.
The effects of IMN-EB radiotherapy on event-free survival and breast cancer-specific survival were benefit for women with moderate-risk breast cancer.
内乳淋巴结（IMN）已被认为是乳腺癌区域扩散的一个潜在部位。本研究的目的是评估内乳淋巴结放疗（RT）对接受乳房切除术和术后放疗的乳腺癌患者临床结局的影响。
这项队列研究纳入了588例位于乳腺中央和内侧象限的乳腺癌患者。320例患者接受了内乳淋巴结放疗，268例患者未接受内乳淋巴结放疗。在内乳淋巴结放疗组中，165例患者接受了外照射内乳淋巴结放疗（IMN-EB）。155例患者接受了乳房切除术联合锎-252中子源植入（IMN-BT）。采用Cox比例风险模型来确定内乳淋巴结放疗对临床结局的影响。评估了年龄、肿瘤大小、淋巴结状态、辅助放疗、化疗和激素治疗情况。
外照射内乳淋巴结放疗显著改善了无远处转移生存期、乳腺癌特异性生存期和总生存期（分别为P = 0.033、P = 0.037和P = 0.011）。外照射内乳淋巴结放疗对中度风险（T1-2N1期）患者的无事件生存期（HR，0.67；95%CI，0.46-0.91；P = 0.043）和乳腺癌特异性生存期（HR，0.64；95%CI，45-0.91；P = 0.013）有显著影响。在任何研究终点中，内乳淋巴结放疗与高危疾病（T3-4N2-3期）患者的临床结局均无关联。
外照射内乳淋巴结放疗对无事件生存期和乳腺癌特异性生存期的影响对中度风险乳腺癌女性有益。
