Thomas F, Arriagada R, Mouriesse H, Sillet-Bach I, Kunkler I, Fontaine F, Le Chevalier T, Contesso G, Sarrazin D
Department of Radiotherapy, Institut Gustave Roussy, Villejuif, France.
Radiother Oncol. 1988 Dec;13(4):267-76. doi: 10.1016/0167-8140(88)90222-8.
This retrospective study involved 319 non-operable breast cancer patients treated by radiotherapy alone with doses of 65 Gy at the Institut Gustave-Roussy (IGR). These patients either had operable tumors but were unfit for general anesthesia or had inoperable tumors due to local contraindications. Most of them had advanced tumors: 21% less than 7 cm; 30% N2 or N3; 30% with inflammatory carcinomas. The 5- and 10-year survival was 40 and 19%, respectively. The local and distant relapse-free rate was 56 and 33% at 5 years and 44 and 28% at 10 years respectively. Results were analyzed according to tumor size, clinical node involvement, histologic grade, age, skin invasion and tumor dose. A multivariate analysis demonstrated that tumor size (p = 10(-3)) and histological grade (HG) (p = 10(-2)) were both significant factors predicting local relapse. Histological grade (p = 10(-3)), tumor size (p = 10(-2)) and clinical node involvement (p = 10(-2)) were the most significant factors predicting distant relapses. An individual risk (IR) of local recurrence and of distant recurrence was defined according to the above factors and was demonstrated to be good prognostic index. Tumor doses above 80 Gy did not increase local control. We recommend the general use of histological grading as it seems important for prediction of local and distant control in patients treated by radiotherapy alone.
这项回顾性研究纳入了319例仅接受放疗的不可手术乳腺癌患者，放疗剂量为65 Gy，均来自古斯塔夫 - 鲁西研究所（IGR）。这些患者要么患有可手术切除的肿瘤但不适合全身麻醉，要么因局部禁忌证而无法手术。他们大多数患有晚期肿瘤：21%的肿瘤小于7厘米；30%为N2或N3期；30%为炎性癌。5年和10年生存率分别为40%和19%。局部和远处无复发生存率在5年时分别为56%和33%，在10年时分别为44%和28%。根据肿瘤大小、临床淋巴结受累情况、组织学分级、年龄、皮肤侵犯和肿瘤剂量对结果进行分析。多因素分析表明，肿瘤大小（p = 10⁻³）和组织学分级（HG）（p = 10⁻²）都是预测局部复发的重要因素。组织学分级（p = 10⁻³）、肿瘤大小（p = 10⁻²）和临床淋巴结受累情况（p = 10⁻²）是预测远处复发的最重要因素。根据上述因素定义了局部复发和远处复发的个体风险（IR），并证明其是良好的预后指标。肿瘤剂量超过80 Gy并未提高局部控制率。我们建议普遍采用组织学分级，因为它对于仅接受放疗患者的局部和远处控制预测似乎很重要。
