Nobler M P, Venet L
Int J Radiat Oncol Biol Phys. 1985 Jul;11(7):1323-31. doi: 10.1016/0360-3016(85)90248-2.
We have evaluated 147 patients who received primary curative irradiation for breast cancer to determine if there were any common factors that predisposed to failure. There were 10 local recurrences, for an overall local control rate of 93.2%, with a 2 to 16 year follow-up. Disease-free survivals were 85% in Stage I, 69% in Stage II, and 50% in Stage III. Age seemed to be a determinant, with a 31.6% local recurrence rate in women under 50 vs. a 3.1% rate of local recurrence in women age 50 or older when treated. We have also noted a correlation between the radiation dose and local recurrence, with a recurrence rate of 9.1% following a dose of 6000 rad or less, vs. a rate of 4.7% with a dose of 6400 rad or more. The size of the primary carcinoma and the status of the axillary lymph nodes, each considered individually, were not significant prognostic factors. There was no relationship between recurrence and the performance of an axillary dissection. There was evidence suggesting that the recurrence rate was lower when a wide local excision was performed, compared to a lesser procedure. Multiple foci of carcinoma and a high nuclear grade appear to have a poor prognosis. Five of the recurrences occurred early (under 2 years) and three of these were accompanied by fatal distant metastases. None of the five patients with late recurrences (37 to 116 months) developed metastatic disease, suggesting that late recurrences may have a better prognosis.
我们评估了147例接受乳腺癌根治性放疗的患者，以确定是否存在任何易导致治疗失败的共同因素。在2至16年的随访中，出现了10例局部复发，总体局部控制率为93.2%。I期患者的无病生存率为85%，II期为69%，III期为50%。年龄似乎是一个决定因素，50岁以下女性的局部复发率为31.6%，而50岁及以上女性接受治疗后的局部复发率为3.1%。我们还注意到放射剂量与局部复发之间的相关性，6000拉德或更低剂量后的复发率为9.1%，而6400拉德或更高剂量后的复发率为4.7%。单独考虑原发性癌的大小和腋窝淋巴结状态，它们并非显著的预后因素。复发与腋窝淋巴结清扫术的实施情况之间没有关系。有证据表明，与范围较小的手术相比，进行广泛局部切除时复发率较低。癌灶多发和核分级高似乎预后较差。5例复发发生在早期（2年以内），其中3例伴有致命的远处转移。5例晚期复发（37至116个月）患者均未发生转移性疾病，这表明晚期复发可能预后较好。
