Solin L J, Fowble B L, Schultz D J, Goodman R L
Department of Radiation Oncology, University of Pennsylvania School of Medicine, Philadelphia.
Int J Radiat Oncol Biol Phys. 1989 Aug;17(2):263-71. doi: 10.1016/0360-3016(89)90438-0.
From 1977 to 1987, 30 women were treated with definitive irradiation following breast-conserving surgery for bilateral carcinoma of the breast for a total of 60 treated breasts. Eleven women presented with concurrent bilateral carcinoma, and 19 women had sequential bilateral carcinoma. Pathologic axillary staging was performed in 51 of the 60 treated breasts. A total dose of greater than or equal to 6,000 cGy was delivered from breast tangential irradiation plus an electron or Iridium boost to 95% (57/60) of the treated breasts. A third field was used to treat the regional axillary and supraclavicular lymph nodes bilaterally in three women (10%) and unilaterally in ten women (33%). Tangential fields were matched at midline in 17 patients, and in ten patients, the tangential fields overlapped by up to 3 cm on skin. In two patients, the tangential fields were matched to an internal mammary nodal field, and in one patient, tangential fields were matched to a mediastinal field given for postoperative radiotherapy for lung cancer. For the overall group of 30 patients, the 5-year actuarial NED survival following treatment of the first breast cancer was 79%, and the 5-year actuarial relapse-free survival was 72%. For the 60 treated breasts, the 5-year actuarial local failure rate was 6%. An analysis of complications and cosmesis showed results similar to previously reported results for unilateral breast cancer. These results show that definitive irradiation following breast-conserving surgery for patients with bilateral breast cancer can technically be delivered with low complication rates and with acceptable survival and local control rates. Definitive irradiation should be considered as an acceptable alternative treatment to bilateral mastectomy for appropriately selected patients with concurrent or sequential bilateral early stage carcinoma of the breast.
1977年至1987年期间，30例双侧乳腺癌患者在保乳手术后接受了根治性放疗，共治疗60个乳房。11例患者为同时性双侧癌，19例患者为序贯性双侧癌。60个接受治疗的乳房中有51个进行了腋窝病理分期。通过乳腺切线照射加电子或铱粒子增敏，60个接受治疗的乳房中有95%（57/60）接受了总剂量大于或等于6000 cGy的照射。3例患者（10%）双侧使用第三野治疗区域腋窝和锁骨上淋巴结，10例患者（33%）单侧使用。17例患者的切线野在中线匹配，10例患者的切线野在皮肤上重叠达3 cm。2例患者的切线野与内乳淋巴结野匹配，1例患者的切线野与肺癌术后放疗的纵隔野匹配。对于30例患者的总体组，首次乳腺癌治疗后的五年精算无疾病生存（NED）率为79%，五年精算无复发生存率为72%。对于60个接受治疗的乳房，五年精算局部失败率为6%。并发症和美容效果分析显示结果与先前报道的单侧乳腺癌结果相似。这些结果表明，双侧乳腺癌患者保乳手术后的根治性放疗在技术上可以实现低并发症率以及可接受的生存率和局部控制率。对于适当选择的同时性或序贯性双侧早期乳腺癌患者，根治性放疗应被视为双侧乳房切除术的可接受替代治疗方法。
