Pierce L J, Oberman H A, Strawderman M H, Lichter A S
Department of Radiation Oncology, University of Michigan Medical School, Ann Arbor 48109, USA.
Int J Radiat Oncol Biol Phys. 1995 Sep 30;33(2):253-9. doi: 10.1016/0360-3016(95)00081-9.
Although the axilla is often treated with radiotherapy (RT) postoperatively when microscopic extracapsular extension (ECE) of lymph nodal metastases is present, little data are available to assess axillary failure in the absence of such treatment. As it has been the practice at this institution to withhold axillary irradiation in the presence of microscopic extracapsular spread, we retrospectively analyzed our results for axillary recurrence, disease-free survival (DFS), and overall survival (OS).
Clinical records were reviewed of 82 women with Stage II node positive breast cancer treated with lumpectomy, axillary dissection, and RT in addition to systemic chemo/hormonal therapy. Axillary surgery consisted of a level I, II, +/- III dissection, with a median of 16.5 nodes removed. Tangential radiotherapy fields were used to treat the breast. All patients were also treated with an abbreviated supraclavicular field with the lateral border medial to the humeral head. Pathological sections were available for review in 72 of the 82 women.
Twenty-seven of 72 (37.5%) had evidence of ECE; 45 of 72 (62.5%) had metastatic carcinoma confined within the nodal capsule. Clinical characteristics were comparable between the patients with and without ECE with the exception of (a) pathologic subtype, with a greater percentage of infiltrating ductal tumors associated with ECE (p = 0.044), and (b) number of positive lymph nodes, with 93% of patients without ECE having one to three positive nodes vs. only 56% among patients with ECE (p < 0.001). With a median follow-up of 40 months, 1 of 27 patients (4%) with ECE experienced an axillary failure as a component of first failure compared to 0 of 45 patients without ECE (p = 0.4). There were no isolated axillary failures. Five-year disease-free survival (72% without ECE vs. 57% with ECE, p = 0.12) and overall survival (83% vs. 53%, respectively, p = 0.068) suggested a less favorable outcome for patients with ECE.
Microscopic ECE appears to be associated with increased axillary involvement and decreased survival rather than subsequent axillary failure. Our data suggest that radiotherapy to a dissected axilla may be omitted for the sole indication of microscopic extracapsular disease.
尽管当存在淋巴结转移的镜下包膜外扩展（ECE）时，腋窝通常在术后接受放射治疗（RT），但在未进行这种治疗的情况下，评估腋窝失败的可用数据很少。由于本机构的惯例是在存在镜下包膜外扩散时不进行腋窝放疗，我们回顾性分析了腋窝复发、无病生存期（DFS）和总生存期（OS）的结果。
回顾了82例II期淋巴结阳性乳腺癌女性患者的临床记录，这些患者接受了肿块切除术、腋窝清扫术以及除全身化疗/激素治疗外的放疗。腋窝手术包括I、II级，±III级清扫，中位切除淋巴结数为16.5个。采用切线野放疗治疗乳腺。所有患者还接受了缩野锁骨上野放疗，其外侧边界位于肱骨头内侧。82例女性患者中有72例有病理切片可供复查。
72例患者中有27例（37.5%）有ECE证据；72例中有45例（62.5%）转移癌局限于淋巴结包膜内。有ECE和无ECE的患者临床特征具有可比性，但存在以下例外情况：（a）病理亚型，浸润性导管癌与ECE相关的比例更高（p = 0.044）；（b）阳性淋巴结数量，无ECE的患者中有93%有1至3个阳性淋巴结，而有ECE的患者中仅为56%（p < 0.001）。中位随访40个月，27例有ECE的患者中有1例（4%）发生腋窝失败作为首次失败的一部分，而45例无ECE的患者中无一例发生腋窝失败（p = 0.4）。没有孤立的腋窝失败病例。五年无病生存期（无ECE者为72%，有ECE者为57%，p = 0.12）和总生存期（分别为83%和53%，p = 0.068）表明有ECE的患者预后较差。
镜下ECE似乎与腋窝受累增加和生存率降低有关，而不是随后的腋窝失败。我们的数据表明，对于镜下包膜外疾病这一唯一指征，可省略对清扫后的腋窝进行放疗。
