Cuzick J, Stewart H, Rutqvist L, Houghton J, Edwards R, Redmond C, Peto R, Baum M, Fisher B, Host H
Imperial Cancer Research Fund, London, United Kingdom.
J Clin Oncol. 1994 Mar;12(3):447-53. doi: 10.1200/JCO.1994.12.3.447.
To examine long-term cause-specific mortality in patients irradiated for breast cancer as part of a randomized clinical trial.
We studied all available information from randomized trials initiated before 1975 in which radiotherapy was the randomized option and surgery was the same for both treatment arms. Eight such trials were identified.
The increased all-cause mortality rate in 10-year survivors previously reported is no longer significant, although a numerical difference in favor of non-irradiated patients remains. This result was strongly influenced by the earliest trials, and more recent trials have found a nonsignificant net benefit in overall mortality associated with radiation therapy. An excess of cardiac deaths was apparent in both early and more recent trials (P < .001), but this was offset by a reduced number of deaths due to breast cancer, especially in more recent trials.
The reduction of breast cancer deaths suggests that radiation therapy may have a value beyond the clearly established improvements obtainable for local control. Use of techniques that minimize cardiac dose is important in reducing the risks of adjuvant radiotherapy, especially in good-prognosis patients.
作为一项随机临床试验的一部分，研究接受乳腺癌放疗患者的长期特定病因死亡率。
我们研究了1975年之前启动的随机试验中的所有可用信息，这些试验中放疗是随机选择的选项，且两个治疗组的手术方式相同。共识别出八项此类试验。
先前报道的10年幸存者中全因死亡率增加的情况不再显著，尽管仍存在有利于未接受放疗患者的数值差异。这一结果受到最早试验的强烈影响，而近期试验发现放疗与总体死亡率相关的净效益不显著。在早期和近期试验中，心脏死亡人数均明显过多（P <.001），但这被乳腺癌死亡人数的减少所抵消，尤其是在近期试验中。
乳腺癌死亡人数的减少表明，放疗可能具有超出已明确确立的局部控制改善效果之外的价值。使用使心脏剂量最小化的技术对于降低辅助放疗的风险很重要，尤其是在预后良好的患者中。
