Danoff B F, Goodman R L, Glick J H, Haller D G, Pajak T F
Int J Radiat Oncol Biol Phys. 1983 Nov;9(11):1625-30. doi: 10.1016/0360-3016(83)90414-5.
From 1978 to 1981, 46 patients received primary radiotherapy following excisional biopsy and axillary staging procedure for Stages I and II carcinoma of the breast. The patients were divided into 2 groups: 27 patients who received radiation and completed 12 cycles of adjuvant chemotherapy (CMF or CMFP) and 19 patients who received radiation alone. All patients received radiation to the breast and regional nodes (4600-5000 rad) and a boost to the site of the primary tumor (1500-2000 rad). Median follow-up from completion of radiation was 26 months in the non-adjuvant and 24 months in the adjuvant group with a range of 12 to 49 months. Cosmesis was judged to be good to excellent in 89% (17/19) of the patients receiving radiation alone and 81% (22/27) of the patients receiving adjuvant chemotherapy. Fair to poor cosmesis in the adjuvant group was attributed primarily to increased fibrosis and reduction of breast size. The single complication for which there was an increased incidence in the adjuvant group was arm edema (22 vs. 0%). The incidence of arm edema was unrelated to T stage, type of axillary surgical procedure, number of positive nodes, addition of prednisone or sequencing of chemotherapy. Further efforts should be directed towards minimizing complications and maximizing cosmesis without sacrificing relapse-free survival in patients receiving primary radiotherapy and adjuvant chemotherapy for early breast cancer.
1978年至1981年期间，46例I期和II期乳腺癌患者在切除活检及腋窝分期手术后接受了根治性放疗。患者被分为两组：27例接受放疗并完成12周期辅助化疗（CMF或CMFP）的患者，以及19例仅接受放疗的患者。所有患者均接受乳腺及区域淋巴结放疗（4600 - 5000拉德），并对原发肿瘤部位进行追加放疗（1500 - 2000拉德）。放疗结束后的中位随访时间，非辅助化疗组为26个月，辅助化疗组为24个月，随访时间范围为12至49个月。在仅接受放疗的患者中，89%（17/19）的患者美容效果被判定为良好至优秀；在接受辅助化疗的患者中，这一比例为81%（22/27）。辅助化疗组美容效果一般至较差主要归因于纤维化增加和乳房体积减小。辅助化疗组中发生率增加的单一并发症是手臂水肿（22% vs. 0%）。手臂水肿的发生率与T分期、腋窝手术方式、阳性淋巴结数量、是否加用泼尼松或化疗顺序无关。对于接受早期乳腺癌根治性放疗和辅助化疗的患者，应进一步努力在不影响无复发生存率的前提下，尽量减少并发症并最大化美容效果。
