Kini V R, White J R, Horwitz E M, Dmuchowski C F, Martinez A A, Vicini F A
Department of Radiation Oncology, William Beaumont Hospital, Royal Oak, Michigan 48073, USA.
Cancer. 1998 Jan 1;82(1):127-33.
Prospective randomized trials and retrospective reviews from academic centers have documented the success of breast-conserving therapy (BCT) for patients with early stage breast carcinoma. The authors retrospectively reviewed the outcome of BCT for early stage breast carcinoma to determine the success of BCT at the study institution, a 1000-bed community hospital.
Between January 1980 and December 1987, 400 cases of Stage I and II breast carcinoma were managed with BCT at the study institution. All patients were treated with an excisional biopsy. The axilla was surgically staged in 383 patients (96%). Postoperative treatment was composed of 45-50 gray (Gy) external beam irradiation to the whole breast and a boost to the tumor bed to at least 60 Gy in all patients. The median follow-up of the 292 surviving patients is 118 months.
At last follow-up, there were 37 local recurrences for 5- and 10-year actuarial rates of 4% and 10%, respectively. Clinical, pathologic, and treatment-related factors were analyzed for an association with local recurrence. On univariate analysis, patient age < or = 35 years and positive surgical margins were associated with an increased risk of local recurrence. On multivariate analysis, only patient age < or = 35 years remained significant. The 10-year actuarial regional recurrence rate was 5%. The 10-year actuarial cause specific survival rate was 91% and 69% for Stage I and II patients, respectively.
BCT for patients with early stage breast carcinoma in a community hospital setting produces excellent results comparable to contemporary series reported from academic institutions and multiinstitution trials.
学术中心的前瞻性随机试验和回顾性研究已证明保乳治疗（BCT）对早期乳腺癌患者的有效性。作者回顾性分析了在一家拥有1000张床位的社区医院中早期乳腺癌保乳治疗的结果，以确定该治疗方法在本研究机构的成效。
1980年1月至1987年12月期间，本研究机构对400例I期和II期乳腺癌患者实施了保乳治疗。所有患者均接受了切除活检。383例患者（96%）进行了腋窝手术分期。所有患者术后均接受全乳45 - 50戈瑞（Gy）的外照射，并对瘤床追加照射至至少60 Gy。292例存活患者的中位随访时间为118个月。
在最后一次随访时，发生了37例局部复发，5年和10年精算局部复发率分别为4%和10%。分析了临床、病理和治疗相关因素与局部复发的相关性。单因素分析显示，年龄≤35岁的患者和手术切缘阳性与局部复发风险增加相关。多因素分析显示，只有年龄≤35岁的患者仍具有统计学意义。10年精算区域复发率为5%。I期和II期患者的10年精算特定病因生存率分别为91%和69%。
在社区医院环境中，早期乳腺癌患者接受保乳治疗可产生优异的结果，与学术机构报告的当代系列研究及多机构试验结果相当。
