Bedwinek J M, Munro D, Fineberg B
Am J Clin Oncol. 1983 Jun;6(3):295-300. doi: 10.1097/00000421-198306000-00007.
High-dose, large volume local-regional irradiation has been shown to be necessary in patients with local-regional recurrence of breast cancer without coexisting distant metastases; however, no studies exist that deal with the dose and volume of local-regional irradiation required for patients with both local-regional recurrence and distant metastases. This report is an analysis of 68 patients who presented with previously untreated local-regional recurrence and coexisting distant metastases. Thirty-five of these patients were treated with local-regional irradiation and systemic therapy; the remaining 33 patients received systemic therapy only. An analysis of the dose and volume in the 35 irradiated patients showed that if the irradiation was inadequate (dose less than 4500 rad and volume not large enough to encompass the entire involved site), the incidence of uncontrolled local-regional disease for the duration of life was 79%, similar to the 64% rate of uncontrolled local-regional disease in the 33 patients not receiving local-regional irradiation. On the other hand, if the dose to the recurrence was at least 4500 rad and if the field was large enough to encompass the entire site containing the recurrence, the incidence of uncontrolled local-regional disease for the duration of life was only 27%. The present study also suggests that local-regional irradiation may be indicated in patients with asymptomatic as well as symptomatic local-regional disease. In patients with distant metastases and initially asymptomatic local-regional disease, adequate irradiation resulted in a lower incidence of ultimate local-regional symptoms when compared to similar patients who were treated with inadequate or no local-regional irradiation. This difference was not quite statistically significant because of the small number of patients in each group.
对于无远处转移共存的局部区域复发乳腺癌患者，大剂量、大体积的局部区域照射已被证明是必要的；然而，目前尚无关于局部区域复发且有远处转移患者所需局部区域照射剂量和体积的研究。本报告分析了68例出现未经治疗的局部区域复发且伴有远处转移的患者。其中35例患者接受了局部区域照射和全身治疗；其余33例患者仅接受了全身治疗。对35例接受照射患者的剂量和体积分析表明，如果照射不充分（剂量小于4500拉德且体积不足以覆盖整个受累部位），终身局部区域疾病未得到控制的发生率为79%，与33例未接受局部区域照射患者中64%的局部区域疾病未得到控制率相似。另一方面，如果对复发部位的照射剂量至少为4500拉德且照射野足够大以覆盖包含复发部位的整个区域，终身局部区域疾病未得到控制的发生率仅为27%。本研究还表明，对于无症状和有症状的局部区域疾病患者，可能都需要进行局部区域照射。在有远处转移且最初无症状的局部区域疾病患者中，与接受不充分或未接受局部区域照射的类似患者相比，充分照射导致最终局部区域症状的发生率较低。由于每组患者数量较少，这种差异在统计学上不太显著。
