Division of Radiation Oncology, European Institute of Oncology, IEO, IRCCS, Milan, Italy.
Radiotherapy Unit, Santa Chiara Hospital, Trento, Italy.
Ann Surg Oncol. 2020 Mar;27(3):752-762. doi: 10.1245/s10434-019-08075-3. Epub 2019 Nov 15.
The aim of this work is to evaluate pattern of care and clinical outcome in a large series of patients with in-breast recurrence (IBR), after quadrantectomy and intraoperative radiation therapy with electrons (IOERT) as partial breast irradiation.
Patients with IBR after IOERT, treated with salvage surgery ± adjuvant reirradiation (re-RT), were selected from a multiinstitution database. Disease-free survival (DFS), overall survival (OS), cumulative incidence of second IBR, and distant metastases (DM) were estimated.
A total of 224/267 patients from seven institutions were included. Primary tumors received 21 Gy. Median time to first IBR was 4.3 years (range 2.6-6.1 years). Salvage mastectomy and repeat quadrantectomy were performed in 135 (60.3%) and 89 (39.7%) patients, followed by adjuvant re-RT in 21/135 (15.5%) and 63/89 (70.8%), respectively. Median follow-up after salvage treatment was 4.1 years. Overall, 5- and 8-year outcomes were as follows: cumulative incidence of second IBR: 8.4% and 14.8%; cumulative incidence of DM: 17.1% and 22.5%; DFS: 67.4% and 52.5%; OS: 89.3% and 74.7%. The risk of second IBR was similar in the salvage mastectomy and repeat quadrantectomy + RT groups [hazard ratio (HR) 1.41, p = 0.566], while salvage mastectomy patients had greater risk of DM (HR 3.15, p = 0.019), as well as poorer DFS (HR 2.13, p = 0.016) and a trend towards worse OS (HR 3.27, p = 0.059). Patients who underwent repeat quadrantectomy alone had worse outcomes (second IBR, HR 5.63, p = 0.006; DFS, HR 3.21, p = 0.003; OS, HR 4.38, p = 0.044) than those adding re-RT.
Repeat quadrantectomy + RT represents an effective salvage approach and achieved local control comparable to that of salvage mastectomy.
本研究旨在评估电子术中放疗（IOERT）行象限切除术保乳术后乳房内局部复发（IBR）患者的治疗模式和临床结局。
从多机构数据库中选择接受挽救性手术加/不加辅助再放疗（re-RT）治疗的 IBR 患者进行研究。无病生存率（DFS）、总生存率（OS）、第二次 IBR 累积发生率和远处转移（DM）的发生率。
来自 7 家机构的 224/267 例患者纳入研究。原发性肿瘤接受 21 Gy 照射。中位首次 IBR 时间为 4.3 年（2.6-6.1 年）。135 例（60.3%）和 89 例（39.7%）患者接受了挽救性乳房切除术和重复象限切除术，其中 21 例（15.5%）和 63 例（70.8%）患者分别接受了辅助 re-RT。挽救性治疗后中位随访时间为 4.1 年。总体而言，5 年和 8 年的结果如下：第二次 IBR 累积发生率分别为 8.4%和 14.8%；DM 累积发生率分别为 17.1%和 22.5%；DFS 分别为 67.4%和 52.5%；OS 分别为 89.3%和 74.7%。挽救性乳房切除术和重复象限切除术+RT 两组患者的第二次 IBR 风险相似[风险比（HR）1.41，p=0.566]，但挽救性乳房切除术患者 DM 风险更高（HR 3.15，p=0.019），DFS 更差（HR 2.13，p=0.016），OS 趋势较差（HR 3.27，p=0.059）。单独行重复象限切除术的患者结局更差（第二次 IBR，HR 5.63，p=0.006；DFS，HR 3.21，p=0.003；OS，HR 4.38，p=0.044）。
重复象限切除术+RT 是一种有效的挽救方法，可达到与挽救性乳房切除术相当的局部控制效果。
