Clarke D, Martinez A, Cox R S, Goffinet D R
Cancer. 1982 Jun 1;49(11):2295-9. doi: 10.1002/1097-0142(19820601)49:11<2295::aid-cncr2820491116>3.0.co;2-g.
Seventy-four patients with carcinoma of the breast were treated by irradiation without a mastectomy at Stanford between May 1973 and March 1980. Seventy-six breasts were treated because two patients had bilateral simultaneous cancers. Breast edema was noted in 41% of these cases. Analysis of potential predisposing factors revealed that this complication occurred primarily in patients who received a staging axillary lymph node dissection. Lymphedema occurred in 26 of 33 breasts (79%) in patients who had staging axillary dissections; this complication developed in only three of 12 (25%) with axillary samplings and two of 31 (6%) with no axillary surgery. Two groups of patients were identified: (1) 28 patients whose breast edema occurred early (prior to or during radiation therapy), and (2) three patients with late onset edema that developed several months postirradiation. The early edema, which is clearly related to axillary lymph node dissection, gradually improved during the follow-up period with complete or near complete resolution expected by three years. Late onset edema was rare, appears to be related to an axillary radiation dose greater than 5500 rad, and may be irreversible. There was no correlation of breast edema with tumor stage, radiation time/dose factors, the use of bolus, patient weight, or breast size.
1973年5月至1980年3月期间，斯坦福大学对74例乳腺癌患者进行了不做乳房切除术的放射治疗。由于两名患者双侧同时患癌，所以共治疗了76个乳房。在这些病例中，41%出现了乳房水肿。对潜在诱发因素的分析显示，这种并发症主要发生在接受分期腋窝淋巴结清扫术的患者中。在进行分期腋窝清扫术的患者中，33个乳房中有26个（79%）出现了淋巴水肿；在进行腋窝采样的12个乳房中，只有3个（25%）出现了这种并发症，在未进行腋窝手术的31个乳房中，只有2个（6%）出现了这种并发症。确定了两组患者：（1）28例乳房水肿早期出现（放疗前或放疗期间）的患者，以及（2）3例放疗后数月出现迟发性水肿的患者。早期水肿显然与腋窝淋巴结清扫有关，在随访期间逐渐改善，预计三年后可完全或接近完全消退。迟发性水肿很少见，似乎与腋窝放射剂量大于5500拉德有关，而且可能是不可逆的。乳房水肿与肿瘤分期、放疗时间/剂量因素、使用推注、患者体重或乳房大小均无相关性。
