Overgaard M, Christensen J J, Johansen H, Nybo-Rasmussen A, Brincker H, van der Kooy P, Frederiksen P L, Laursen F, Panduro J, Sørensen N E
Department of Oncology, Radiumstationen, Aarhus, Denmark.
Acta Oncol. 1988;27(6A):707-14. doi: 10.3109/02841868809091773.
All pre- and postmenopausal high-risk breast cancer patients in the protocols DBCG 77 of the Danish Breast Cancer Cooperative Group received postmastectomy irradiation before randomization to either adjuvant systemic therapy or no such treatment. The actuarial loco-regional recurrence rate at 9 years was 6-17%, with the lowest rate in patients who also received additional adjuvant chemotherapy or tamoxifen. In a subsequent study (DBCG 82) the role of postmastectomy irradiation together with systemic treatment was evaluated in high-risk patients. Pre- and menopausal patients were randomized to postmastectomy irradiation + CMF (cyclophosphamide, methotrexate, 5-fluorouracil), CMF alone or CMF + TAM (tamoxifen). Postmenopausal patients were randomized to postmastectomy irradiation + TAM, TAM or CMF + TAM. At 4 years the loco-regional recurrence rate was significantly lower in the irradiated patients (5-7% vs. 23-33%). Further, disease-free survival was significantly improved in both pre- and postmenopausal irradiated patients compared with those who had only systemic treatment. At present, there are no significant differences between survival in the treatment groups. Thus, adjuvant systemic treatment alone (chemotherapy and/or tamoxifen) did not prevent loco-regional recurrences in high-risk patients after mastectomy and axillary lymph node sampling. However, a longer observation time is necessary to evaluate the consequence of primary optimal loco-regional tumour control in high-risk breast cancer patients with respect to survival.
丹麦乳腺癌协作组方案DBCG 77中的所有绝经前和绝经后高危乳腺癌患者在随机接受辅助全身治疗或不接受此类治疗之前均接受了乳房切除术后放疗。9年时的精算局部区域复发率为6%-17%，在同时接受额外辅助化疗或他莫昔芬的患者中复发率最低。在随后的一项研究（DBCG 82）中，对高危患者乳房切除术后放疗联合全身治疗的作用进行了评估。绝经前和绝经患者被随机分为乳房切除术后放疗+CMF（环磷酰胺、甲氨蝶呤、5-氟尿嘧啶）组、单纯CMF组或CMF+TAM（他莫昔芬）组。绝经后患者被随机分为乳房切除术后放疗+TAM组、TAM组或CMF+TAM组。4年时，接受放疗的患者局部区域复发率显著降低（5%-7%对23%-33%）。此外，与仅接受全身治疗的患者相比，绝经前和绝经后接受放疗的患者无病生存率均显著提高。目前，各治疗组的生存率无显著差异。因此，单纯辅助全身治疗（化疗和/或他莫昔芬）并不能预防高危患者乳房切除和腋窝淋巴结清扫术后的局部区域复发。然而，需要更长的观察时间来评估高危乳腺癌患者原发性最佳局部区域肿瘤控制对生存的影响。
