Recht A, Come S E, Henderson I C, Gelman R S, Silver B, Hayes D F, Shulman L N, Harris J R
Joint Center for Radiation Therapy, Beth Israel Hospital, Boston, MA 02215, USA.
N Engl J Med. 1996 May 23;334(21):1356-61. doi: 10.1056/NEJM199605233342102.
Patients with early-stage breast cancer who are at substantial risk for systemic metastases are increasingly treated with breast-conserving therapy and adjuvant chemotherapy. However, the optimal sequencing of chemotherapy and radiation therapy is not clear.
Two hundred forty-four patients with stage I or II breast cancer who were at substantial risk for distant metastases were randomly assigned to receive a 12-week course of chemotherapy either before or after radiation therapy. All had had breast-conserving surgery. The median length of follow-up in surviving patients was 58 months (range, 10 to 124).
The five-year actuarial rates of cancer recurrence at any site and of distant metastases in the radiotherapy-first group and the chemotherapy-first group were 38 percent and 31 percent (P = 0.17) and 36 percent and 25 percent (P = 0.05), respectively. Overall survival was 73 percent and 81 percent (P = 0.11), respectively. The five-year crude rates of first recurrence according to site in the radiotherapy-first and chemotherapy-first groups, respectively, were 5 percent and 14 percent for local recurrence and 32 percent and 20 percent for distant or regional recurrence or both. This difference in the pattern of recurrence was of borderline statistical significance (P = 0.07).
This study suggests that for patients ar substantial risk for systemic metastases, it is preferable to give a 12-week course of chemotherapy followed by radiation therapy, rather than radiation therapy followed by chemotherapy.
有较高全身转移风险的早期乳腺癌患者越来越多地接受保乳治疗和辅助化疗。然而，化疗和放疗的最佳顺序尚不清楚。
244例有较高远处转移风险的Ⅰ期或Ⅱ期乳腺癌患者被随机分配在放疗前或放疗后接受为期12周的化疗。所有患者均接受了保乳手术。存活患者的中位随访时间为58个月（范围10至124个月）。
放疗先于化疗组和化疗先于放疗组的任何部位癌症复发和远处转移的五年精算率分别为38%和31%（P = 0.17）以及36%和25%（P = 0.05）。总生存率分别为73%和81%（P = 0.11）。放疗先于化疗组和化疗先于放疗组根据复发部位的五年首次复发粗率，局部复发分别为5%和14%，远处或区域复发或两者均有分别为32%和20%。这种复发模式的差异具有临界统计学意义（P = 0.07）。
本研究表明，对于有较高全身转移风险的患者，先给予为期12周的化疗然后进行放疗，优于先进行放疗然后化疗。
