Cooke A L, Perera F, Fisher B, Opeitum A, Yu N
Department of Radiation Oncology, London Regional Cancer Centre, University of Western Ontario, Canada.
Int J Radiat Oncol Biol Phys. 1995 Feb 15;31(4):777-81. doi: 10.1016/0360-3016(94)00499-4.
To determine the effect of tamoxifen on local control after partial mastectomy with and without adjuvant breast irradiation.
A retrospective study of 97 node positive patients identified from the records of the London Regional Cancer Center included 44 patients who received tamoxifen and breast irradiation (40 or 50 Gy plus booster dose) after partial mastectomy, and 53 patients who received tamoxifen only after partial mastectomy. Base line characteristics of the two groups were similar.
At 39 months actuarial follow-up there was a breast tumor recurrence (BTR) in 5% vs. 21% of patients when radiation was omitted (p = 0.0388), but there was no difference in the cause-specific mortality of the two treatment groups. Cox Regression analysis (on only 10 BTR) showed age and adjuvant radiation as significant predictors of BTR. In patients not receiving radiation, no BTR was seen in 22 patients > or = 70 years of age at diagnosis vs. 8 BTR in 31 patients < 70 years (p = 0.0130). All BTR occurred while patients were receiving tamoxifen.
Tamoxifen alone with omission of radiation after partial mastectomy provides inferior breast tumor control in node positive patients. This is especially true for patients under 70 years of age. Patients aged 70 years or older at the time of diagnosis of breast cancer who receive tamoxifen have a low rate of breast tumor recurrence when radiation is omitted. These patients represent a group for whom radiation might not be necessary.
确定他莫昔芬对保乳手术后局部控制的影响，无论是否进行辅助性乳房放疗。
一项回顾性研究，从伦敦地区癌症中心的记录中识别出97例淋巴结阳性患者，其中44例患者在保乳手术后接受了他莫昔芬和乳房放疗（40或50 Gy加增强剂量），53例患者在保乳手术后仅接受了他莫昔芬治疗。两组的基线特征相似。
在39个月的精算随访中，未进行放疗时，患者的乳腺肿瘤复发率分别为5%和21%（p = 0.0388），但两个治疗组的特定病因死亡率没有差异。Cox回归分析（仅针对10例乳腺肿瘤复发）显示年龄和辅助放疗是乳腺肿瘤复发的重要预测因素。在未接受放疗的患者中，诊断时年龄≥70岁的22例患者未出现乳腺肿瘤复发，而年龄<70岁的31例患者中有8例出现乳腺肿瘤复发（p = 0.0130）。所有乳腺肿瘤复发均发生在患者接受他莫昔芬治疗期间。
保乳手术后仅使用他莫昔芬而不进行放疗，对淋巴结阳性患者的乳腺肿瘤控制效果较差。对于70岁以下的患者尤其如此。诊断为乳腺癌时年龄≥70岁且接受他莫昔芬治疗的患者，在不进行放疗时乳腺肿瘤复发率较低。这些患者可能是不需要放疗的人群。
