Zucali R, Uslenghi C, Kenda R, Bonadonna G
Cancer. 1976 Mar;37(3):1422-31. doi: 10.1002/1097-0142(197603)37:3<1422::aid-cncr2820370325>3.0.co;2-y.
This retrospective study evaluates the time and site of relapse as well as the median survival of 454 consecutive patients with T3-T4 Nx Mo breast cancer treated with radiation therapy from 1968 to 1972. Radiotherapy was delivered with kilovoltage to the first 221 patients and with cobalt to 233 patients, respectively. A group of 133 selected patients was subjected to radical mastectomy 6-8 weeks after completion of the irradiation. The incidence of first relapse was 45% within the first 18 months from starting radiotherapy. The incidence of relapse was higher in presence than in absence of regional adenopathy, with no statistical difference between T3 and T4. Inflammatory carcinoma showed the highest percent of relapse during the first 12 months (48%). The relapse rate appeared independent from type of irradiation. The site of first relapse occurred more often (68%) in areas distant from irradiation fields. Sterilization of both primary tumor and regional nodes was obtained only in 10% of patients. The median survival for the whole series was 2.5 years, with no significant difference between roentgen therapy (3 years) and cobalt (2.5 years). Unfavorable survival was directly related to the presence of regional adenopathies (2.3 years), especially in the supraclavicular fossa (1.4 years) and of inflammatory carcinoma (1.2 years). Patients treated with radiotherapy followed by surgery showed a median survival of 3.9 years compared to 2.1 years for those given only irradiation. The importance of sequentially combining chemotherapy with radiotherapy is discussed.
本回顾性研究评估了1968年至1972年间接受放射治疗的454例连续T3 - T4 Nx M0期乳腺癌患者的复发时间和部位以及中位生存期。分别对前221例患者采用千伏放疗，对233例患者采用钴放疗。一组133例选定患者在放疗结束后6 - 8周接受了根治性乳房切除术。放疗开始后的前18个月内首次复发率为45%。存在区域淋巴结病时的复发率高于不存在时，T3和T4之间无统计学差异。炎性癌在最初12个月内的复发率最高(48%)。复发率似乎与放疗类型无关。首次复发部位更常出现在(68%)远离放疗野的区域。仅10%的患者实现了原发肿瘤和区域淋巴结的清除。整个系列的中位生存期为2.5年，X线放疗(3年)和钴放疗(2.5年)之间无显著差异。生存情况不佳与区域淋巴结病的存在直接相关(2.3年)，尤其是在锁骨上窝(1.4年)和炎性癌(1.2年)。接受放疗后手术的患者中位生存期为3.9年，而仅接受放疗的患者为2.1年。文中讨论了化疗与放疗序贯联合的重要性。
