Veronesi U, Luini A, Del Vecchio M, Greco M, Galimberti V, Merson M, Rilke F, Sacchini V, Saccozzi R, Savio T
Istituto Nazionale per lo Studio e la Cura dei Tumori, Milan, Italy.
N Engl J Med. 1993 Jun 3;328(22):1587-91. doi: 10.1056/NEJM199306033282202.
Conservative surgery and radiotherapy have become well-established treatments for breast cancer, and many trials in progress are attempting to define the most acceptable type of procedure. Between 1987 and 1989 we randomly assigned 567 women with small breast cancers (< 2.5 cm in diameter) to quadrantectomy followed by radiotherapy or to quadrantectomy without radiotherapy. All patients underwent total axillary dissection. The median follow-up period was 39 months (range, 28 to 54).
The incidence of local recurrence was 8.8 percent among the patients treated with quadrantectomy without radiotherapy, as compared with 0.3 percent among those treated with postsurgical radiotherapy (P = 0.001). However, there was a substantial effect of age: patients more than 55 years old who did not receive radiotherapy had a low rate of local recurrence (3.8 percent). The four-year overall survival was similar in the two treatment groups.
Administering radiotherapy after quadrantectomy reduces the risk of local recurrence in women with small cancers of the breast, but radiotherapy may not be necessary in elderly women.
保守手术和放射治疗已成为乳腺癌的成熟治疗方法，目前许多正在进行的试验试图确定最可接受的手术类型。1987年至1989年期间，我们将567例患有小乳腺癌（直径<2.5 cm）的女性随机分为两组，一组接受象限切除术后放疗，另一组接受象限切除术但不放疗。所有患者均接受了全腋窝清扫术。中位随访期为39个月（范围28至54个月）。
未接受放疗的象限切除术患者局部复发率为8.8%，而术后放疗患者的局部复发率为0.3%（P = 0.001）。然而，年龄有显著影响：55岁以上未接受放疗的患者局部复发率较低（3.8%）。两个治疗组的四年总生存率相似。
象限切除术后进行放疗可降低小乳腺癌女性的局部复发风险，但老年女性可能无需放疗。
