Abdel-Wahab M, Wolfson A, Raub W, Mies C, Brandon A, Morrell L, Lee Y, Ling S, Markoe A
Department of Radiation Oncology, University of Miami, Jackson Memorial Hospital, Sylvester Comprehensive Cancer Center, FL, USA.
Int J Radiat Oncol Biol Phys. 1998 Mar 1;40(4):875-80. doi: 10.1016/s0360-3016(97)00897-3.
To determine the impact of postoperative radiation on locoregional relapse and overall survival rate in a multimodality protocol for locally advanced breast cancer (LABC).
Of the patients entered in the protocol, 55 were evaluable. Treatment consisted of: neoadjuvant MVAC (methotrexate, vinblastine, adriamycin, and cisplatin) until a maximum response had been achieved; modified radical mastectomy; 6 courses of postoperative adjuvant MVAC chemotherapy, and chest wall irradiation (CWXRT). Multivariate analysis of locoregional response and overall survival was done.
Of the total, 42 patients received chest wall radiation; 28 of these also received radiation to regional lymph nodes. Chest wall doses ranged from 45 Gy to 50.4 Gy to the whole chest wall, with 31 patients receiving an additional chest-wall boost. The incidence of locoregional relapse with and without radiation was 7% vs. 31%, respectively (p = 0.026). An overall survival benefit was seen in those receiving radiation, with a mean overall survival of 50 months vs. 20 months, and a 3-year overall survival of 88% vs. 46% with and without radiation, respectively (p = 0.003). Multivariate analysis showed that overall survival was affected by the presence of pathological CR (p = .047), the number of pre-operative chemotherapy cycles (p = .036) and whether or not they received radiation (p = 0.003). Neither the interval between surgery and radiation, technique of radiation, nor radiation modality significantly affected local control.
The significant improvement in local regional control and overall survival with the addition of radiation suggests that radiation should be an integral part of multimodality management of locally advanced breast cancer.
确定术后放疗对局部晚期乳腺癌（LABC）多模式治疗方案中局部区域复发和总生存率的影响。
进入该方案的患者中，55例可评估。治疗包括：新辅助MVAC（甲氨蝶呤、长春碱、阿霉素和顺铂）直至达到最大反应；改良根治性乳房切除术；6个疗程的术后辅助MVAC化疗，以及胸壁照射（CWXRT）。对局部区域反应和总生存率进行多变量分析。
总共42例患者接受了胸壁放疗；其中28例还接受了区域淋巴结放疗。胸壁剂量范围为整个胸壁45 Gy至50.4 Gy，31例患者接受了额外的胸壁加量照射。接受放疗和未接受放疗的局部区域复发率分别为7%和31%（p = 0.026）。接受放疗的患者显示出总生存获益，接受放疗和未接受放疗的患者平均总生存期分别为50个月和20个月，3年总生存率分别为88%和46%（p = 0.003）。多变量分析显示，总生存受病理完全缓解的存在（p = 0.047）、术前化疗周期数（p = 0.036）以及是否接受放疗（p = 0.003）的影响。手术与放疗之间的间隔、放疗技术以及放疗方式均未显著影响局部控制。
放疗的加入使局部区域控制和总生存率显著提高，这表明放疗应成为局部晚期乳腺癌多模式治疗的一个组成部分。
