Renner H, van Kampen M
Klinik und Institut für Strahlentherapie, Klinikum Nürnberg-Nord.
Strahlenther Onkol. 1994 Aug;170(8):441-52.
The aim of this study was to create a treatment policy for macroscopic persistent tumor (R2) in the case of locoregional recurrent breast cancer after mastectomy. The large amount of persisting tumor cells before radiation therapy requires an aggressive therapeutic regime as known by literature. In this tumor situation our therapeutic concept is the combined simultaneous radiation and chemotherapy.
A retrospective evaluation of treatment and follow-up data of 71 patients was made. The median follow-up was 26.4 months. The local radiation therapy was combined with simultaneous chemotherapy, radiotherapy was triggered by the rhythm of chemotherapy: chemotherapy was given by CMF regime with modification according to dosage. Duration of chemotherapy was 2 weeks followed by 2 weeks without any therapy. Four courses of this regime were given. Irradiation was done simultaneously to chemotherapy using a split course technique. All patients had a visible and palpable macroscopic residual tumor before starting therapy so that the result of therapy could be documented easily.
At the end of the therapy the complete remission rate (CR) was 89%. This was not depending on radiation dose if more than 30.00 Gy were given. For patients with CR the 5-year-probability of a re-recurrence infield is 29%. The rate of re-recurrence was depending on radiation dose. Increasing the dosage by boost technique above 50.00 Gy decreased re-recurrence to 50% of the value found by dosage of less than 50.00 Gy. Due to ipsilateral re-recurrence outfield the 5-year-probability for ipsilateral local tumor to be controlled continuously is 45%. The median overall survival rate of all patients was 32.5 months. Patients without haematogenous metastases at the beginning of the therapy and continuous local tumor control reached a median survival rate of 42.6 months in contrast to patients with haematogenous metastases or no local tumor control which had a median survival rate of 26.3 months (p < 0.04).
The combined simultaneous radio-chemotherapy in the case of locoregionally recurrent breast cancer with macroscopic residual tumor (R2) is a successful treatment concept. A prospective study was initiated by ARO study group of the German Cancer Society to improve these data.
本研究的目的是制定一项针对乳房切除术后局部区域复发性乳腺癌中存在肉眼可见持续性肿瘤（R2）的治疗策略。放疗前存在大量残留肿瘤细胞，需要如文献中所知的积极治疗方案。在这种肿瘤情况下，我们的治疗理念是同步放化疗联合应用。
对71例患者的治疗及随访数据进行回顾性评估。中位随访时间为26.4个月。局部放疗联合同步化疗，放疗根据化疗节奏进行：化疗采用CMF方案，并根据剂量进行调整。化疗持续2周，随后2周不进行任何治疗。共进行四个疗程。采用分割疗程技术与化疗同时进行放疗。所有患者在开始治疗前均有肉眼可见且可触及的残留肿瘤，因此治疗结果易于记录。
治疗结束时，完全缓解率（CR）为89%。如果给予超过30.00 Gy的剂量，这与放疗剂量无关。对于CR患者，5年内野内复发概率为29%。复发率取决于放疗剂量。通过追加技术将剂量增加至50.00 Gy以上，复发率降至剂量低于50.00 Gy时的50%。由于同侧野外复发，5年内同侧局部肿瘤持续得到控制的概率为45%。所有患者的中位总生存率为32.5个月。治疗开始时无血行转移且局部肿瘤持续得到控制的患者，中位生存率为42.6个月，而有血行转移或局部肿瘤未得到控制的患者，中位生存率为26.3个月（p < 0.04）。
对于局部区域复发性乳腺癌伴有肉眼可见残留肿瘤（R2）的情况，同步放化疗联合应用是一种成功的治疗理念。德国癌症协会的ARO研究组已启动一项前瞻性研究以完善这些数据。
