Prosnitz L R, Goldenberg I S, Packard R A, Levene M B, Harris J, Hellman S, Wallner P E, Brady L W, Mansfield C M, Kramer S
Cancer. 1977 Feb;39(2 Suppl):917-23. doi: 10.1002/1097-0142(197702)39:2+<917::aid-cncr2820390730>3.0.co;2-2.
This report describes 150 patients with clinical stage I and II carcinoma of the breast treated at four institutions--Yale University School of Medicine, Harvard Medical School-Joint Center for Radiation Therapy, Hahnemann Medical College, Jefferson Medical College--with radiotherapy only following excisional biopsy. Closely similar treatment policies were followed at all four centers, 4500-5000 rads minimum tumor dose being delivered to the entire breast and axillary, supraclavicular and internal mammary nodes. Forty-six of 49 stage I patients treated are alive without disease, the actuarial relapse-free survival being 91% at 5 years. Of the 101 stage II patients, 75 are alive without disease with a relapse-free actuarial survival of 60% at 5 years. Local failure has occurred in 10 patients (9 stage II and 1 stage I, 6.6%) 5 of whom are disease-free following mastectomy. The results obtained in this study are comparable to those of conventional surgery. It is our conclusion that mastectomy is not a necessary part of the treatment of small breast cancers, that radiation without mastectomy is an acceptable alternative with far superior cosmetic and functional results. Adjuvant chemotherapy should be considered particularly in stage II patients in view of their 40% relapse rate.
本报告描述了150例临床I期和II期乳腺癌患者，这些患者在四个机构——耶鲁大学医学院、哈佛医学院联合放射治疗中心、哈内曼医学院、杰斐逊医学院——接受治疗，仅在切除活检后进行放射治疗。四个中心都遵循了极为相似的治疗策略，向整个乳房以及腋窝、锁骨上和乳腺内淋巴结给予至少4500 - 5000拉德的肿瘤剂量。接受治疗的49例I期患者中有46例存活且无疾病，5年时无病生存率的精算值为91%。101例II期患者中，75例存活且无疾病，5年时无病生存率的精算值为60%。10例患者（9例II期和1例I期，6.6%）出现局部复发，其中5例在乳房切除术后无疾病。本研究获得的结果与传统手术的结果相当。我们的结论是，乳房切除术并非小乳腺癌治疗的必要部分，不进行乳房切除术的放射治疗是一种可接受的替代方案，其美容和功能效果远优于乳房切除术。鉴于II期患者40%的复发率，应特别考虑辅助化疗。
