Ytredal D O, Zeigler M G, Hagen R O, Bradfield J S
South Med J. 1977 Jun;70(6):698-701. doi: 10.1097/00007611-197706000-00018.
Recurrence patterns were analyzed in 323 patients treated by radical mastectomy, 219 of whom received postoperative irradiation. Thirty-five patients with inner quadrant lesions and negative axillary nodes received postoperative regional node irradiation; 33 of these 35 patients are alive without recurrence from 2 to 22 years later. Six of 219 patients receiving postoperative regional lymph node irradiation developed recurrence in the treated area. In patients with positive axillary nodes, 27% of all recurrence developed initially in the chest wall region, and an additional 10% of patients developed distant metastases in addition to chest wall recurrence. The high incidence of chest wall recurrence in patients with four or more positive nodes, and in patients with two or three positive nodes and primary lesions over 3 cm in diameter who did not receive chest wall irradiation, suggests that the maximal benefit from postoperative irradiation would not be realized in prospective, randomized studies without the use of chest wall irradiation postoperatively in these categories of patients.
对323例行根治性乳房切除术的患者的复发模式进行了分析，其中219例接受了术后放疗。35例内象限病变且腋窝淋巴结阴性的患者接受了术后区域淋巴结放疗；这35例患者中有33例在2至22年后仍存活且无复发。219例接受术后区域淋巴结放疗的患者中有6例在治疗区域出现复发。在腋窝淋巴结阳性的患者中，所有复发患者中有27%最初发生在胸壁区域，另有10%的患者除胸壁复发外还发生了远处转移。在有四个或更多阳性淋巴结的患者，以及有两个或三个阳性淋巴结且原发灶直径超过3 cm但未接受胸壁放疗的患者中，胸壁复发的发生率较高，这表明在这些类型的患者中，如果术后不使用胸壁放疗，前瞻性随机研究将无法实现术后放疗的最大益处。
