McCormick B, Norton L, Yao T J, Yahalom J, Petrek J A
Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA.
Cancer J Sci Am. 1996 Jan-Feb;2(1):39-45.
We conducted this study to evaluate the effects of delaying primary radiation after adjuvant chemotherapy on local control following breast-conserving surgery compared with radiation delivered immediately following surgery.
This retrospective, nonrandomized study evaluated local control in 471 patients treated with breast-conserving surgery and radiation from 1980 through 1990. Three patient subsets were studied, identified by the sequence of radiation and adjuvant therapy if given. The three subgroups were: surgery, radiation, no chemohormonal therapy (332 patients; RT only); surgery, all chemotherapy, radiation (53 patients; chemo first); and surgery, chemotherapy, radiation, chemotherapy (86 patients; sandwich). Median follow-up times ranged from 53 months in the chemo first group to 77 months in the RT only group.
All three groups had similar local control rates at 3 and 5 years. At 36 months, the actuarial local control rate achieved by the RT only group was 98% (confidence interval: 95%-99%); by the chemo first group, 94% (CI: 82%-98%); and the sandwich group, 96% (CI: 89%-99%). At 60 months, the local control rate for the RT only group was 96% (CI: 93%-98%), the chemo first group, 86% (CI: 70%-94%) and the sandwich group 95% (CI: 87%-98%).
This report demonstrates no significant difference in the local recurrence rate following breast-conserving surgery and radiation therapy, whether radiation immediately followed the surgery or whether it was delayed by the administration of postsurgical adjuvant chemotherapy. These data differ from other reports, and suggest that this question remains open, requiring further follow-up that focuses not only on local control as an endpoint, but disease-free and overall survival as well.
我们开展这项研究，旨在评估保乳手术后辅助化疗后延迟进行初次放疗与术后立即放疗相比，对局部控制的影响。
这项回顾性、非随机研究评估了1980年至1990年期间接受保乳手术和放疗的471例患者的局部控制情况。研究了三个患者亚组，根据放疗和辅助治疗（若有）的顺序进行区分。三个亚组分别为：手术、放疗、无化学激素治疗（332例患者；仅放疗）；手术、所有化疗、放疗（53例患者；先化疗）；以及手术、化疗、放疗、化疗（86例患者；夹心方案）。中位随访时间从先化疗组的53个月到仅放疗组的77个月不等。
所有三个组在3年和5年时的局部控制率相似。在36个月时，仅放疗组的精算局部控制率为98%（置信区间：95%-99%）；先化疗组为94%（CI：82%-98%）；夹心组为96%（CI：89%-99%）。在60个月时，仅放疗组的局部控制率为96%（CI：93%-98%），先化疗组为86%（CI：70%-94%），夹心组为95%（CI：87%-98%）。
本报告表明，保乳手术和放疗后局部复发率无显著差异，无论放疗是在手术后立即进行还是因术后辅助化疗而延迟。这些数据与其他报告不同，表明这个问题仍未解决，需要进一步随访，不仅要将局部控制作为终点，还要关注无病生存期和总生存期。
