Zhao Xu-Ran, Xuan Liang, Yin Jun, Tang Yu, Sun Hui-Ru, Jing Hao, Song Yong-Wen, Jin Jing, Liu Yue-Ping, Fang Hui, Ren Hua, Chen Bo, Tang Yuan, Li Ning, Qi Shu-Nan, Lu Ning-Ning, Yang Yong, Li Ye-Xiong, Sun Bing, Wu Shi-Kai, Wang Shu-Lian
Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Department of Radiation Oncology, The Fifth Medical Center, Chinese People's Liberation Army (PLA) General Hospital, Beijing, China.
Front Oncol. 2021 Feb 10;10:600525. doi: 10.3389/fonc.2020.600525. eCollection 2020.
Optimal radiation target volumes for breast cancer patients with their first isolated chest wall recurrence (ICWR) after mastectomy are controversial. We aimed to analyze the regional failure patterns and to investigate the role of prophylactic regional nodal irradiation (RNI) for ICWR.
Altogether 205 patients with ICWR after mastectomy were retrospectively analyzed. Post-recurrence progression-free survival (PFS) and overall survival (OS) rates were calculated by Kaplan-Meier method and the differences were compared with Log-rank test. Competing risk model was used to estimate the subsequent regional recurrence (sRR) and locoregional recurrence (sLRR) rates, and the differences were compared with Gray test.
The 5-year sRR rate was 25.2% with median follow-up of 88.6 months. Of the 52 patients with sRR, 30 (57.7%) recurred in the axilla, 29 (55.8%) in supraclavicular fossa (SC), and five (9.6%) in internal mammary nodes. Surgery plus radiotherapy was independently associated with better sLRR and PFS rates (p<0.001). The ICWR interval of ≤ 4 years was associated with unfavorable sRR (p=0.062), sLRR (p=0.014), PFS (p=0.001), and OS (p=0.005). Among the 157 patients who received radiotherapy after ICWR, chest wall plus RNI significantly improved PFS (p=0.004) and OS (p=0.021) compared with chest wall irradiation alone. In the 166 patients whose ICWR interval was ≤ 4 years, chest wall plus RNI provided the best PFS (p<0.001) and OS (p=0.022) compared with chest wall irradiation alone or no radiotherapy.
Patients with ICWR have a high-risk of sRR in SC and axilla. Chest wall plus RNI is recommended.
乳腺癌患者乳房切除术后首次孤立性胸壁复发（ICWR）的最佳放疗靶区存在争议。我们旨在分析区域复发模式，并探讨预防性区域淋巴结照射（RNI）对ICWR的作用。
对205例乳房切除术后发生ICWR的患者进行回顾性分析。采用Kaplan-Meier法计算复发后无进展生存期（PFS）和总生存期（OS）率，并通过Log-rank检验比较差异。使用竞争风险模型估计后续区域复发（sRR）和局部区域复发（sLRR）率，并通过Gray检验比较差异。
中位随访88.6个月，5年sRR率为25.2%。在52例发生sRR的患者中，30例（57.7%）在腋窝复发，29例（55.8%）在锁骨上窝（SC）复发，5例（9.6%）在内乳淋巴结复发。手术加放疗与更好的sLRR和PFS率独立相关（p<0.001）。ICWR间隔≤4年与不良的sRR（p=0.062）、sLRR（p=0.014）、PFS（p=0.001）和OS（p=0.005）相关。在157例ICWR后接受放疗的患者中，胸壁加RNI与单纯胸壁照射相比，显著改善了PFS（p=0.004）和OS（p=0.021）。在166例ICWR间隔≤4年的患者中，与单纯胸壁照射或不放疗相比，胸壁加RNI提供了最佳的PFS（p<0.001）和OS（p=0.022）。
ICWR患者在SC和腋窝有较高的sRR风险。推荐胸壁加RNI。
