Denham J W, Strickland P
Eur J Cancer Clin Oncol. 1984 Feb;20(2):189-96. doi: 10.1016/0277-5379(84)90183-4.
In order to improve the long-term cosmetic results following the radical irradiation of primary breast cancer at Mount Vernon Hospital, dosage was reduced in the early 1970s. The clinical impression that local recurrence had become more frequent at the reduced dose level led to an early review of the results. This report details the results in 159 patients who formed the two largest groups of patients treated between 1968 and 1980. Sixty-five patients were treated between 1968 and 1973, using 6500 cGy to the whole breast in 25 daily fractions over 5 weeks, with alternate breast fields treated each day. Forty-two of these patients were with TNM stage I and II disease [TNM Classification of Malignant Tumours, Geneva, UICC, 1978] and had 5-yr actuarial survival and local recurrence figures of 59 and 10% respectively. The corresponding figures in 52 patients with stage I and II disease treated between 1974 and 1980 with 5500 cGy to the whole breast in 25 daily fractions over 5 weeks with both breast fields treated each day were 79 and 26.6%. In spite of the small numbers involved and the bias in favour of the latter group of patients, who had a greater proportion of T1,N0 lesions, the difference in local recurrence rate in favour of the former group (who received 6500 cGy) almost reached statistical significance at the 0.05 level. A difference was also observed when the two subgroups of stage I and II patients who had had their primaries excised prior to irradiation were compared. The 23 patients with TNM stage IIIa and b disease treated with 6500 cGy between 1968 and 1973 had similar local recurrence (49.7% at 18 months) and survival experience (32.5% at 5 yr) to the 42 similarly staged patients treated with 5500 cGy between 1974 and 1980 (48 and 36.4% respectively). It is possible that the addition of combination cytotoxic therapy to the primary management in 12 patients with stage IIIb disease in the latter group favourably influenced the local control data obtained. Cosmetic results were substantially better in the groups receiving 5500 cGy, with approximately 20% developing disfiguring retraction and skin changes. In contrast, these sequelae were almost inevitable in the patients who received 6500 cGy.
为了改善在弗农山医院对原发性乳腺癌进行根治性放疗后的长期美容效果，20世纪70年代初降低了放疗剂量。临床印象是在较低剂量水平下局部复发变得更加频繁，这促使人们对结果进行早期回顾。本报告详细介绍了159例患者的结果，这些患者构成了1968年至1980年间接受治疗的两组最大患者群体。1968年至1973年间，对65例患者进行治疗，在5周内每天分25次给予全乳6500厘戈瑞，每天交替照射双侧乳房野。其中42例患者为TNM I期和II期疾病[《恶性肿瘤TNM分类》，日内瓦，国际抗癌联盟，1978年]，5年精算生存率和局部复发率分别为59%和10%。1974年至1980年间，对52例I期和II期疾病患者进行治疗，在5周内每天分25次给予全乳5500厘戈瑞，每天照射双侧乳房野，相应的5年精算生存率和局部复发率分别为79%和26.6%。尽管涉及的病例数较少，且后一组患者中T1、N0病变的比例较高存在偏差，但前一组（接受6500厘戈瑞）局部复发率较低的差异几乎在0.05水平上达到统计学显著性。当比较两组在放疗前已切除原发灶的I期和II期患者亚组时，也观察到了差异。1968年至1973年间接受6500厘戈瑞治疗的23例TNM IIIa和IIIb期疾病患者，其局部复发率（18个月时为49.7%）和生存情况（5年时为32.5%）与1974年至1980年间接受5500厘戈瑞治疗的42例同样分期患者（分别为48%和36.4%）相似。后一组中12例IIIb期疾病患者在初始治疗中加用联合细胞毒性疗法可能对所获得的局部控制数据产生了有利影响。接受5500厘戈瑞治疗的组美容效果明显更好，约20%的患者出现毁容性回缩和皮肤改变。相比之下，接受6500厘戈瑞治疗的患者几乎不可避免地会出现这些后遗症。
