Weichselbaum R R, Marck A, Hellman S
Cancer. 1976 Jun;37(6):2682-90. doi: 10.1002/1097-0142(197606)37:6<2682::aid-cncr2820370617>3.0.co;2-w.
Chest wall and regional nodal recurrences, and survival following postmastectomy radiation therapy, were analyzed in 352 patients. Patients with T1 and T2 central and medial breast lesions, negative axillary nodal findings, and no evidence of skin or chest wall extension received irradiation to the peripheral lymphatics alone. There were no chest wall recurrences among these patients. The remainder of the patients, including those with axillary nodal involvement, regardless of the site of the primary breast lesion received irradiation by a three-field technique directed to both chest wall and regional nodes. The chest wall recurrence rate was 1.9% when axillary nodes were negative for metastatic disease, 1.3% when the axillary nodes showed less than 50% positivity, and 14.2% when axillary nodes showed greater than 50% involvement. The overall chest wall recurrence rate was 5.1%. A possible mechanism of chest wall recurrence is discussed. Cumulative 5-year survival for stage I is 76%, for stage II, 79%, and for stage III, 57%. If chemotherapy proves to be effective in controlling distant microscopic disease local control may become an equally critical issue in long-term survival of patients with breast carcinoma.
对352例患者进行了胸壁和区域淋巴结复发以及乳房切除术后放疗后的生存情况分析。T1和T2期中央及内侧乳腺病变、腋窝淋巴结阴性且无皮肤或胸壁侵犯证据的患者仅接受外周淋巴管照射。这些患者中无胸壁复发。其余患者，包括有腋窝淋巴结受累的患者，无论原发性乳腺病变部位如何，均采用针对胸壁和区域淋巴结的三野技术进行照射。腋窝淋巴结无转移时胸壁复发率为1.9%，腋窝淋巴结阳性率低于50%时为1.3%，腋窝淋巴结受累率大于50%时为14.2%。总体胸壁复发率为5.1%。讨论了胸壁复发的可能机制。I期患者的5年累积生存率为76%，II期为79%，III期为57%。如果化疗被证明能有效控制远处微小病灶，那么局部控制可能成为乳腺癌患者长期生存中同样关键的问题。
