Ragaz J, Jackson S M, Le N, Plenderleith I H, Spinelli J J, Basco V E, Wilson K S, Knowling M A, Coppin C M, Paradis M, Coldman A J, Olivotto I A
Department of Medical Oncology, British Columbia Cancer Agency, Vancouver, Canada.
N Engl J Med. 1997 Oct 2;337(14):956-62. doi: 10.1056/NEJM199710023371402.
Radiotherapy after mastectomy to treat early breast cancer has been known since the 1940s to reduce rates of local relapse. However, the routine use of postoperative radiotherapy began to decline in the 1980s because it failed to improve overall survival. We prospectively tested the efficacy of combining radiotherapy with chemotherapy.
From 1978 through 1986, 318 premenopausal women with node-positive breast cancer were randomly assigned, after modified radical mastectomy, to receive chemotherapy plus radiotherapy or chemotherapy alone. Radiotherapy was given to the chest wall and locoregional lymph nodes between the fourth and fifth cycles of cyclophosphamide, methotrexate, and fluorouracil.
After 15 years of follow-up, the women assigned to chemotherapy plus radiotherapy had a 33 percent reduction in the rate of recurrence (relative risk, 0.67; 95 percent confidence interval, 0.50 to 0.90) and a 29 percent reduction in mortality from breast cancer (relative risk, 0.71; 95 percent confidence interval, 0.51 to 0.99), as compared with the women treated with chemotherapy alone.
Radiotherapy combined with chemotherapy after modified radical mastectomy decreases rates of locoregional and systemic relapse and reduces mortality from breast cancer.
自20世纪40年代以来，人们就知道乳房切除术后进行放射治疗可降低早期乳腺癌的局部复发率。然而，由于术后放疗未能提高总体生存率，其常规应用在20世纪80年代开始减少。我们前瞻性地测试了放疗与化疗联合应用的疗效。
从1978年至1986年，318例绝经前淋巴结阳性乳腺癌妇女在改良根治性乳房切除术后被随机分配，分别接受化疗加放疗或单纯化疗。放疗在环磷酰胺、甲氨蝶呤和氟尿嘧啶的第四和第五周期之间给予胸壁和局部区域淋巴结。
经过15年的随访，与单纯接受化疗的妇女相比，接受化疗加放疗的妇女复发率降低了33%（相对风险，0.67；95%置信区间，0.50至0.90），乳腺癌死亡率降低了29%（相对风险，0.71；95%置信区间，0.51至0.99）。
改良根治性乳房切除术后放疗联合化疗可降低局部区域和全身复发率，并降低乳腺癌死亡率。
