Dewar J A, Sarrazin D, Benhamou E, Petit J Y, Benhamou S, Arriagada R, Fontaine F, Castaigne D, Contesso G
Int J Radiat Oncol Biol Phys. 1987 Apr;13(4):475-81. doi: 10.1016/0360-3016(87)90060-5.
Between June 1970 and April 1982, 592 patients with unilateral T1 and small T2 breast cancers were managed conservatively at the Institut Gustave-Roussy. The treatment policy for the axilla was to perform a lower axillary dissection and to proceed to axillary clearance ( +/- radiotherapy) in patients with axillary invasion by tumor (N+). Some N+ patients had only lower axillary dissection and radiotherapy. Five hundred fifty-eight patients underwent axillary surgery which was a lower axillary dissection in 374 patients (67%) and axillary clearance in 184 patients (33%). There was axillary invasion in 198 cases (36%). Only five patients relapsed in the axilla and the probability of axillary relapse at 5 years was 1.2%. There were no axillary relapses in N+ patients who had had an axillary clearance whether irradiated or not. The incidence of upper limb complications was significantly greater in patients undergoing axillary surgery and radiotherapy compared with axillary surgery alone (p less than 0.0001). It is concluded that a lower axillary dissection accurately identifies N-patients and an axillary clearance in N+ patients ensures good local control and avoids the morbidity associated with axillary irradiation.
1970年6月至1982年4月期间，古斯塔夫 - 鲁西研究所对592例单侧T1期和小T2期乳腺癌患者进行了保守治疗。腋窝的治疗策略是进行低位腋窝清扫术，对于有肿瘤腋窝侵犯（N+）的患者进行腋窝淋巴结清除术（±放疗）。一些N+患者仅接受了低位腋窝清扫术和放疗。558例患者接受了腋窝手术，其中374例（67%）进行了低位腋窝清扫术，184例（33%）进行了腋窝淋巴结清除术。有198例（36%）存在腋窝侵犯。仅有5例患者腋窝复发，5年时腋窝复发的概率为1.2%。接受腋窝淋巴结清除术的N+患者，无论是否接受放疗，均未出现腋窝复发。与单纯腋窝手术相比，接受腋窝手术和放疗的患者上肢并发症的发生率显著更高（p<0.0001）。结论是，低位腋窝清扫术能准确识别N-患者，N+患者进行腋窝淋巴结清除术可确保良好的局部控制，并避免与腋窝放疗相关的发病率。
