Pierce L J, Glatstein E
Department of Radiation Oncology, University of Michigan Medical School, Ann Arbor 48109-0010.
Cancer. 1994 Jul 1;74(1 Suppl):477-85. doi: 10.1002/cncr.2820741337.
There is a long and detailed history of radiation therapy as an adjuvant to surgery in operable breast cancer. The results of a large number of randomized clinical trials will be reviewed. They can be summarized by saying that although the trials show a reduction in local-regional failure with the use of postoperative radiotherapy, a survival advantage has not been clearly identified. Many of the older trials used techniques and radiation doses inadequate by current standards, which may have affected the results. Recent trials that used therapeutic doses of radiation, however, did demonstrate a survival advantage among patients who received postoperative radiotherapy. These trials generally have included chemotherapy and required careful integration of radiotherapy and systemic therapy. Although all trials have not demonstrated a survival benefit by the addition of radiotherapy, the ability to maintain local-regional control after mastectomy is an important goal. Administration of prophylactic chest wall and nodal radiotherapy to patients at high risk for local-regional recurrence significantly reduces the chance of a local treatment failure. Because a chest wall recurrence is a distressing event that dramatically affects quality of life, improved local-regional control with postoperative radiotherapy is a highly significant end point.
在可手术乳腺癌中，放射治疗作为手术辅助手段有着悠久而详尽的历史。本文将回顾大量随机临床试验的结果。可以总结为，尽管这些试验表明术后放疗可降低局部区域复发率，但尚未明确证实其具有生存优势。许多早期试验所采用的技术和放射剂量按当前标准是不足的，这可能影响了结果。然而，近期使用治疗性放射剂量的试验确实表明，接受术后放疗的患者具有生存优势。这些试验通常包括化疗，并且需要仔细整合放疗和全身治疗。尽管并非所有试验都证明增加放疗能带来生存益处，但在乳房切除术后维持局部区域控制的能力是一个重要目标。对局部区域复发高危患者进行预防性胸壁和淋巴结放疗可显著降低局部治疗失败的几率。由于胸壁复发是一个令人痛苦的事件，会极大地影响生活质量，因此通过术后放疗改善局部区域控制是一个非常重要的终点。
