Riet F G, Fayard F, Arriagada R, Santos M A, Bourgier C, Ferchiou M, Heymann S, Delaloge S, Mazouni C, Dunant A, Rivera S
Department of Radiation Oncology, Gustave Roussy, Villejuif, France.
Department of Biostatistics and Epidemiology, Gustave Roussy, Villejuif, France.
Eur J Cancer. 2017 May;76:45-51. doi: 10.1016/j.ejca.2017.01.022. Epub 2017 Mar 6.
This study evaluates the long-term outcomes of a retrospective cohort of breast cancer (BC) patients who had received curatively intended premastectomy radiation therapy (RT). We analysed locoregional control, disease-free survival (DFS) and overall survival (OS), pathological complete remission (pCR), predictors thereof, and immediate safety. The series consisted of 187 patients with a median age of 49 years [43-60] and T2-T4 or N2 tumours. Between 1970 and 1984, they had received slightly hypofractionated RT to the whole breast, ipsilateral supraclavicular fossa and axilla ± the internal mammary chain (45-55 Gy/18 fractions of 2.5 Gy/34 days) systematically followed by a modified radical mastectomy with an axillary dissection. No other preoperative treatment was given. Among the 166 centrally reviewed tumour biopsy specimens, 22% had a triple-negative (TN) phenotype, 17% were HER2 3 + or amplified and 61% were ER+. The median follow-up was 32 years [23-35]. The 25-year locoregional control rate was 89% [93%-82%] and the 25-year DFS and OS rates were identical, 30% [24%-37%]. A pCR in the tumour and lymph nodes had been achieved in 18 among all patients (10%), but in 26% with TN disease. In the multivariate analysis, the TN status was the only predictive factor of pCR (OR = 5.49, 95% confidence interval [CI] 1.87-16.1, p = 0.002). Also, the pN status (HR = 1.69, [1.28-2.22], p = 0.0002) and TN subtype (HR = 1.80, [1.00-3.26], p = 0.05) exerted a significant prognostic impact on OS. The postoperative complication rate (grade >2) was 19% with 4.3% of localized skin necrosis. Preoperative RT followed by radical surgery is feasible and associated with good long-term locoregional control.
本研究评估了接受根治性乳房切除术前放疗（RT）的乳腺癌（BC）患者回顾性队列的长期结局。我们分析了局部区域控制、无病生存期（DFS）和总生存期（OS）、病理完全缓解（pCR）、其预测因素以及即刻安全性。该队列由187例患者组成，中位年龄49岁[43 - 60岁]，肿瘤为T2 - T4期或N2期。在1970年至1984年期间，他们接受了对全乳、同侧锁骨上窝和腋窝±内乳链的轻度超分割放疗（45 - 55 Gy/18次，每次2.5 Gy/34天），随后系统性地进行改良根治性乳房切除术及腋窝淋巴结清扫。未给予其他术前治疗。在166份经中心审核的肿瘤活检标本中，22%为三阴性（TN）表型，17%为HER2 3 +或扩增型，61%为ER +型。中位随访时间为32年[23 - 35年]。25年局部区域控制率为89%[93% - 82%]，25年DFS和OS率相同，均为30%[24% - 37%]。所有患者中有18例（10%）实现了肿瘤和淋巴结的pCR，但TN疾病患者中这一比例为26%。在多变量分析中，TN状态是pCR的唯一预测因素（OR = 5.49，95%置信区间[CI] 1.87 - 16.1，p = 0.002）。此外，pN状态（HR = 1.69，[1.28 - 2.22]，p = 0.0002）和TN亚型（HR = 1.
