Olivotto I A, Weir L M, Kim-Sing C, Bajdik C D, Trevisan C H, Doll C M, Lam W Y, Basco V E, Jackson S M
Division of Radiation Oncology, British Columbia Cancer Agency, Vancouver, Canada.
Radiother Oncol. 1996 Oct;41(1):7-13. doi: 10.1016/s0167-8140(96)91824-1.
The number of fractions of radiation therapy (RT) used after breast conserving surgery varies widely and accounts for a significant proportion of the workload in a modern radiotherapy department. Internationally, 'standard' therapy ranges from 3 to 7 weeks of daily treatment with or without a boost. Short RT schedules have the attraction of reducing workload but raise concern about an increased risk of late effects and poorer cosmetic outcome.
In a randomized trial, 186 women with T1 or T2, pathologically node-negative breast cancer had cosmetic and various normal tissue effects data collected prospectively. The breast RT prescription was 44 Gy in 16 daily fractions to a tangent pair.
Median follow-up is 6.7 years. Actuarial 5-year breast recurrence was 6%. Overall cosmetic results at 5 years were good or excellent in 89% and 96% as reported by physicians and patients, respectively, and were stable between 2 and 5 years. Breast discomfort, erythema, edema and induration were related to both surgery and RT. At 5 years, 20% had breast discomfort, 18% had induration, 6% had erythema and 3% had some degree of breast edema. Fewer patients had these effects at 5 years than immediately after primary surgery. The presence of induration prior to starting RT was associated with a greater likelihood of breast induration 3 or more years following RT (P = 0.02). Thirteen percent of patients, generally those with large breasts, developed mild inframammary telangiectasia by 5 years.
Results are comparable to those reported from centers employing more conventional fractionation. Short fractionation produces acceptable cosmetic results for the majority of women if there are no contraindications to RT and in the absence of significant post-operative breast induration.
保乳手术后放射治疗（RT）的分割次数差异很大，在现代放疗科室的工作量中占很大比例。在国际上，“标准”治疗方案为每日治疗3至7周，有或无追加剂量。短程放疗计划虽有减少工作量的吸引力，但引发了对后期效应风险增加和美容效果较差的担忧。
在一项随机试验中，前瞻性收集了186例T1或T2期、病理检查淋巴结阴性的乳腺癌女性患者的美容及各种正常组织效应数据。乳腺放疗处方为对切线野每日分割照射16次，总剂量44 Gy。
中位随访时间为6.7年。5年精算乳腺复发率为6%。医生和患者报告的5年总体美容效果分别为89%和96%为良好或优秀，且在2至5年期间保持稳定。乳腺不适、红斑、水肿和硬结与手术和放疗均有关。5年时，20%的患者有乳腺不适，18%有硬结，6%有红斑，3%有一定程度的乳腺水肿。5年时出现这些效应的患者比初次手术后即刻更少。放疗开始前存在硬结与放疗后3年或更长时间出现乳腺硬结的可能性更大相关（P = 0.02）。到5年时，13%的患者（通常是乳房较大的患者）出现轻度乳房下毛细血管扩张。
结果与采用更传统分割方案的中心报告的结果相当。如果没有放疗禁忌证且术后无明显乳腺硬结，短程分割放疗对大多数女性可产生可接受的美容效果。
