Price P, Walsh G, McKinna A J, Ashley S, Yarnold J R
Academic Radiotherapy Unit, Royal Marsden Hospital, Sutton, Surrey, U.K.
Radiother Oncol. 1988 Sep;13(1):53-60. doi: 10.1016/0167-8140(88)90298-8.
One hundred patients with breast recurrence have been identified from patients at the Royal Marsden Hospital, treated by local excision +/- radiotherapy for early stage primary invasive breast cancer between 1961 and 1985. The mean follow-up was 58 months (range 1 month - 19 years). In 74/100 patients, breast recurrence occurred within the breast parenchyma, was not associated with systemic relapse and carried a relatively good prognosis with a median survival of 77 months from the time of breast relapse. In 67 patients with parenchymal relapse in whom the site of relapse could be reliably compared with that of the original tumour, 60 (90%) patients developed recurrent tumours at or close to the primary site. In 24/100 patients, breast recurrence occurred in the overlying skin and in only two of these patients (2% of total) did recurrence actually occur within the scar tissue. Skin relapse was associated with systemic relapse and carried a relatively poor prognosis with a median survival of 36 months from the time of recurrence. The pattern of breast relapse was similar in irradiated and unirradiated patients. Skin relapse appears to be a manifestation of metastatic disease while parenchymal relapse may represent regrowth of primary tumour. This pattern of breast relapse questions the requirement for radiotherapy to the whole breast after local excision for early stage breast cancer.
从皇家马斯登医院的患者中识别出100例乳腺癌复发患者，这些患者在1961年至1985年间因早期原发性浸润性乳腺癌接受了局部切除±放疗。平均随访时间为58个月（范围1个月至19年）。在100例患者中的74例中，乳腺复发发生在乳腺实质内，与全身复发无关，预后相对较好，从乳腺复发时起的中位生存期为77个月。在67例实质复发患者中，复发部位可与原发肿瘤部位可靠比较，60例（90%）患者在原发部位或其附近出现复发性肿瘤。在100例患者中的24例中，乳腺复发发生在上覆皮肤，其中只有2例患者（占总数的2%）的复发实际发生在瘢痕组织内。皮肤复发与全身复发相关，预后相对较差，从复发时起的中位生存期为36个月。接受放疗和未接受放疗的患者乳腺复发模式相似。皮肤复发似乎是转移性疾病的一种表现，而实质复发可能代表原发性肿瘤的再生长。这种乳腺复发模式对早期乳腺癌局部切除后全乳放疗的必要性提出了质疑。
