Hille-Betz Ursula, Vaske Bernhard, Bremer Michael, Soergel Philipp, Kundu Sudip, Klapdor Rüdiger, Hillemanns Peter, Henkenberens Christoph
Department of Obstetrics and Gynaecology, Hannover Medical School, Hannover, Germany.
Institute of Medical Biometry and Informatics, Hannover Medical School, Hannover, Germany.
Strahlenther Onkol. 2016 Jan;192(1):8-16. doi: 10.1007/s00066-015-0899-y. Epub 2015 Sep 28.
The purpose of this work was to identify parameters influencing the risk of late radiation side effects, fair or poor cosmetic outcomes (COs) and pain in breast cancer patients after breast-conserving therapy (BCT) and three-dimensional conformal radiotherapy (3D-CRT).
Between 2006 and 2013, 159 patients were treated at the Hannover Medical School. Physician-rated toxicity according to the LENT-SOMA criteria, CO and pain were assessed by multivariate analysis.
LENT-SOMA grade 1-4 toxicity was observed as follows: fibrosis 10.7 %, telangiectasia 1.2 %, arm oedema 8.8 % and breast oedema 5.0 %. In addition, 15.1 % of patients reported moderate or severe breast pain, and 21.4 % complained about moderate or severe pain in the arm or shoulder. In multivariate analysis, axillary clearing (AC) was significantly associated with lymphoedema of the arm [odds ratio (OR) 4.37, p = 0.011, 95 % confidence interval (CI) 1.4-13.58]. Breast oedema was also highly associated with AC (OR 10.59, p = 0.004, 95 % CI 2.1-53.36), a ptosis grade 2/3 or pseudoptosis and a bra size ≥ cup C (OR 5.34, p = 0.029, 95 % CI 1.2-24.12). A ptosis grade 2/3 or pseudoptosis and a bra size ≥ cup C were the parameters significantly associated with an unfavourable CO (OR 3.19, p = 0.019, 95 % CI 1.2-8.4). Concerning chronic breast pain, we found a trend related to the prescribed radiation dose including boost (OR 1.077, p = 0.060, 95 % CI 0.997-1.164). Chronic shoulder or arm pain was statistically significantly associated with lymphoedema of the arm (OR 3.9, p = 0.027, 95 % CI 1.17-13.5).
Chronic arm and breast oedema were significantly influenced by the extent of surgery (AC). Ptotic and large breasts were significantly associated with unfavourable COs and chronic breast oedema. Late toxicities exclusive breast pain were not associated with radiotherapy parameters.
本研究旨在确定影响保乳治疗（BCT）及三维适形放疗（3D-CRT）后乳腺癌患者发生晚期放射副作用、美容效果一般或较差（CO）及疼痛风险的参数。
2006年至2013年间，汉诺威医学院共治疗了159例患者。根据LENT-SOMA标准对医生评定的毒性进行评估，并通过多因素分析评估美容效果和疼痛情况。
观察到LENT-SOMA 1-4级毒性如下：纤维化10.7%，毛细血管扩张1.2%，手臂水肿8.8%，乳腺水肿5.0%。此外，15.1%的患者报告有中度或重度乳腺疼痛，21.4%的患者抱怨手臂或肩部有中度或重度疼痛。多因素分析显示，腋窝清扫（AC）与手臂淋巴水肿显著相关[比值比（OR）4.37，p = 0.011，95%置信区间（CI）1.4 - 13.58]。乳腺水肿也与AC高度相关（OR 10.59，p = 0.004，95% CI 2.1 - 53.36）、乳房下垂2/3级或假性下垂以及胸罩尺寸≥C罩杯（OR 5.34，p = 0.029，95% CI 1.2 - 24.12）。乳房下垂2/3级或假性下垂以及胸罩尺寸≥C罩杯是与不良美容效果显著相关的参数（OR 3.19，p = 0.019，95% CI 1.2 - 8.4）。关于慢性乳腺疼痛，我们发现与包括瘤床加量在内的处方放射剂量存在一定趋势相关（OR 1.077，p = 0.060，95% CI 0.997 - 1.164）。慢性肩部或手臂疼痛与手臂淋巴水肿在统计学上显著相关（OR 3.9，p = 0.027，95% CI 1.17 - 13.5）。
慢性手臂和乳腺水肿受手术范围（AC）的显著影响。乳房下垂和乳房较大与不良美容效果及慢性乳腺水肿显著相关。除乳腺疼痛外的晚期毒性与放疗参数无关。
