Ray G R, Fish V J, Marmor J B, Rogoway W, Kushlan P, Arnold C, Lee R H, Marzoni F
Int J Radiat Oncol Biol Phys. 1984 Jun;10(6):837-41. doi: 10.1016/0360-3016(84)90385-7.
Cosmesis and complication rates were examined in patients with early stage carcinoma of the breast treated by biopsy and radiation therapy with and without adjuvant chemotherapy in an attempt to determine the effect of chemotherapy upon these parameters. Between April 1, 1975 and June 1, 1980, 51 patients were treated with radiation therapy and adjuvant chemotherapy (XRT + ACT) and 83 patients with radiotherapy alone (XRT). Chemotherapy usually consisted of cytoxan, methotrexate and 5-fluorouracil for 6 or 12 cycles. Minimum follow-up was 36 months. Cosmetic results deteriorated with time in both groups but to a greater extent in the XRT + ACT group. At 36 months, excellent cosmetic results were obtained in 73 of the 83 patients (88%) in the XRT group compared to 37 of 51 patients (73%) in the XRT + ACT group (p = less than .05). Comparison of the two treatment groups revealed that complication rates were significantly increased in the XRT + ACT group. Of the 51 patients in the XRT + ACT group, 21 patients (41%) suffered complications compared to 8 (10%) of the 83 patients in the XRT group (p = less than .001). This difference in complication rates resulted primarily from an increased incidence in the XRT + ACT group of wet desquamation in the electron beam portal used to treat the internal mammary lymph nodes and a trend towards a higher incidence of spontaneous nonpathologic rib fractures, myositis and arm edema. An increased incidence of nonbreast primary cancers was not seen. Our preliminary conclusions are that adjuvant chemotherapy has a negative impact upon cosmesis and complication rates in patients being treated with definitive radiotherapy. However, cosmetic results remain satisfactory and complication rates are maintained at an acceptable level. Continued close follow-up will be required before definitive conclusions can be reached as to the overall incidence and severity of the changes noted.
对接受活检及放疗的早期乳腺癌患者，在有或无辅助化疗的情况下，检查其美容效果及并发症发生率，以确定化疗对这些指标的影响。1975年4月1日至1980年6月1日期间，51例患者接受了放疗及辅助化疗（XRT + ACT），83例患者仅接受放疗（XRT）。化疗通常由环磷酰胺、甲氨蝶呤和5-氟尿嘧啶组成，共6或12个周期。最短随访时间为36个月。两组的美容效果均随时间恶化，但XRT + ACT组恶化程度更大。36个月时，XRT组83例患者中有73例（88%）获得了极佳的美容效果，而XRT + ACT组51例患者中仅有37例（73%）（p < 0.05）。两组治疗的比较显示，XRT + ACT组的并发症发生率显著增加。XRT + ACT组的51例患者中，21例（41%）出现并发症，而XRT组的83例患者中有8例（10%）（p < 0.001）。并发症发生率的差异主要源于XRT + ACT组在用于治疗内乳淋巴结的电子束照射野中湿性脱屑发生率增加，以及自发性非病理性肋骨骨折、肌炎和手臂水肿发生率有升高趋势。未发现非乳腺癌原发癌的发生率增加。我们的初步结论是，辅助化疗对接受根治性放疗的患者的美容效果和并发症发生率有负面影响。然而，美容效果仍令人满意，并发症发生率也维持在可接受水平。在对所观察到变化的总体发生率和严重程度得出明确结论之前，需要持续密切随访。
