Libson Shai, Perez Eduardo, Takita Christiane, Avisar Eli
Department of General Surgery, Miami University School of Medicine, Miami, USA.
Department of Radiation Oncology, Miami University School of Medicine, Miami, USA.
Eur J Breast Health. 2019 Apr 1;15(2):71-75. doi: 10.5152/ejbh.2019.4481. eCollection 2019 Apr.
Post mastectomy radiation (PMR) is usually recommended for T3 or N2 breast cancer (BC). The role of PMR for stage II BC with T1/T2 lesions remains controversial. The aim of this study was to assess the role of PMR in this subgroup of patients.
A retrospective analysis of a prospectively collected database of all stage II BC patients treated with mastectomy at our institution between the years 2005-2008 was performed. Demographics, disease-free survival rates were compared between the patients receiving radiation vs. those who were not irradiated.
Eighty-two patients underwent mastectomies for stage II disease with a T1/T2 lesion. Twenty-two of those (27%) received PMR. Loco regional recurrence (LRR) occurred only in the non -irradiated (NR) group. A Kaplan Meier analysis of time to LRR in the NR group was performed. Mean time to local failure was 78.9 months, 6% at 3 years and 13% at 5 years. The time to LRR was significantly lower in the estrogen receptor (ER) negative group compared to the ER positive group (64 vs. 82 months, p=0.029). LRR free rate at 5 years was 100% in low grade tumors vs. 53% in high grade tumors, (p=0.001). In a Cox regression multivariate analysis none of those factors maintained significance.
ER negative status, high grade and node negativity were associated with LRR. A prospective trial randomizing stage II BC patients with T1/T2 lesions, negative hormone receptors and high-grade tumors to PMR following mastectomy arm vs. no radiation arm is recommended.
乳房切除术后放疗（PMR）通常推荐用于T3或N2期乳腺癌（BC）。PMR在T1/T2期II期BC中的作用仍存在争议。本研究的目的是评估PMR在该亚组患者中的作用。
对2005年至2008年间在我院接受乳房切除术的所有II期BC患者的前瞻性收集数据库进行回顾性分析。比较接受放疗与未接受放疗患者的人口统计学、无病生存率。
82例患者因II期疾病伴T1/T2病变接受了乳房切除术。其中22例（27%）接受了PMR。局部区域复发（LRR）仅发生在未接受放疗（NR）组。对NR组的LRR时间进行了Kaplan Meier分析。局部失败的平均时间为78.9个月，3年时为6%，5年时为13%。雌激素受体（ER）阴性组的LRR时间显著低于ER阳性组（64个月对82个月，p=0.029）。低级别肿瘤5年无LRR率为100%，高级别肿瘤为53%，（p=0.001）。在Cox回归多变量分析中，这些因素均未保持显著性。
ER阴性状态、高级别和无淋巴结转移与LRR相关。建议进行一项前瞻性试验，将T1/T2病变、激素受体阴性和高级别肿瘤的II期BC患者随机分为乳房切除术后接受PMR组与未接受放疗组。
