Beadle G F, Silver B, Botnick L, Hellman S, Harris J R
Cancer. 1984 Dec 15;54(12):2911-8. doi: 10.1002/1097-0142(19841215)54:12<2911::aid-cncr2820541216>3.0.co;2-v.
In order to assess the cosmetic results of treatment, the results in 239 patients with early breast cancer treated by primary radiation treatment without adjuvant chemotherapy were reviewed. Four patients had bilateral cancers, making a total of 243 breasts available for analysis. Follow-up ranged from 24 to 78 months with a median of 33 months. The parameters measured were breast edema, retraction, telangiectasia, arm edema, and the overall cosmetic appearance. The cosmetic results declined over the first 3 years after treatment, but then stabilized. At 5 years, the overall cosmetic results were judged by physicians as excellent in 77%, good in 9%, fair in 9%, and poor in 5%. A fair or poor cosmetic result was highly correlated with the development of moderate or severe breast retraction. Telangiectasia was uncommonly the only cause of a fair or poor cosmetic result. Breast and arm edema were rarely noted to be significant, but were more common in patients who underwent axillary dissection. In 210 cases, a supplementary boost dose of radiation was delivered to the primary tumor area, and in 33 cases a boost was not used. This boost consisted of an interstitial iridium-192 implant in 204 cases and either high-energy photons or electrons in the remainder. At 4 years, no patient treated without a boost had a fair or poor result compared with 22% who received a boost (P = 0.13). The conclusion is that, in general, primary radiation treatment provides highly satisfactory cosmetic results for patients with early breast cancer.
为评估治疗的美容效果，我们回顾了239例接受单纯放疗而非辅助化疗的早期乳腺癌患者的治疗结果。4例患者为双侧乳腺癌，因此共有243个乳房可供分析。随访时间为24至78个月，中位随访时间为33个月。所测量的参数包括乳腺水肿、回缩、毛细血管扩张、手臂水肿以及整体美容外观。美容效果在治疗后的前3年有所下降，但随后趋于稳定。5年时，医生判断整体美容效果为优的占77%，良的占9%，中平的占9%，差的占5%。美容效果为中平或差与中度或重度乳腺回缩的发生高度相关。毛细血管扩张很少是美容效果中平或差的唯一原因。乳腺和手臂水肿很少被认为有显著影响，但在接受腋窝清扫的患者中更为常见。210例患者对原发肿瘤区域给予了补充加量放疗，33例患者未进行加量。204例患者的加量采用组织间铱-192植入，其余患者采用高能光子或电子束。4年时，未接受加量放疗的患者无一例美容效果为中平或差，而接受加量放疗的患者这一比例为22%（P = 0.13）。结论是，总体而言，单纯放疗为早期乳腺癌患者提供了非常令人满意的美容效果。
