乳腺癌伴腋窝淋巴结转移术后放射治疗研究(附78例≥8个淋巴结转移的乳腺癌临床观察)  

Postoperative adjuvant radiation therapy in breast cancer patients with positive axillary lymph nodes :observation of 78 cases

作　　者：王淑莲[1] 余子豪[1] 韩嘉珠[1] 刘新帆[1] 

机构地区：[1]中国医学科学院中国协和医科大学肿瘤医院放射治疗科,北京100021

出　　处：《中华放射肿瘤学杂志》1999年第4期211-214,共4页Chinese Journal of Radiation Oncology

摘　　要：目的　探讨放射治疗对腋窝淋巴结转移数≥8 个、T1 ～3 期乳腺癌的作用。方法　回顾性分析78 例行根治术的浸润性乳腺癌。术后均接受辅助化疗,疗程0.5 ～4.0 个;38 例兼接受了术后放射治疗,放射治疗部位为同侧锁骨上、下及内乳淋巴引流区,且29 例加胸壁、25 例加腋窝,放射治疗剂量45 Gy 以上占89.5 % 。结果　放射治疗组和未放射治疗组的5 年局部复发率分别为30 .8%和57.4 %( P= 0.010) ;5 年无瘤生存率分别为47 .7% 和15.7% ( P= 0 .002) ;5 年总生存率分别为64.4% 和40.6% (P= 0.083) 。做和未做胸壁足量放射治疗的胸壁复发率为7 .7 % (2/26) 和3/9 (P<0 .05)。做和未做腋窝放射治疗的腋窝复发率为4 .0% (1/25)和7 .7 % (1/13)(P> 0.05)。结论　对腋窝淋巴结转移数≥8 个、T1～3 期乳腺癌,除术后化疗外,应常规行术后放射治疗,胸壁应列为常规的照射部位之一。Objective To determine the effect of postoperative adjuvant radiation therapy for breast cancer patients with T 1～3 and eight or more positive axillary lymph nodes. Methods Seventy eight patients treated between 1983 and 1991 in Cancer Hospital of Chinese Academy of Medical Science were retrospectively analyzed, All patients, with histologically confirmed invasive carcinomas of the breast, received half to four courses of adjuvant chemotherapy after radical surgery. Radiation therapy to the ipsilateral supraclavicular, infraclavicular and internal mammary nodes with or without chest wall and axillary nodes was given to 38 patients, the majority were treated to a dose of more than 45 Gy. Results For the radiation group and no radiation group, the five year initial locoregional recurrence rates were 30.8% and 57.4% (P=0.010), the disease free survival rates were 47.7% and 15.7%(P=0.002), the overall survival rates were 64.4% and 40.6%(P=0.083), respectively. The crude chest wall recurrence rate was 7.7% (2/26) for the patients who received chest wall irradiation as compared with 3/9 for the patients who did not receive chest wall irradiation. The crude axilla recurrence rate was 4.0% (1/25) for the patients who received axilla irradiation as compared with 7.7% (1/13) for the patients who did not received axilla irradiation. Conclusions Besides adjuvant chemotherapy, radiation therapy should be routinely given to the breast cancer patients with T 1～3 and eight or more positive axillary lymph nodes. In radiation therapy, chest wall should be one of the routine irradiated sites, axillary irradiation is not necessary.

关 键 词：放射疗法 生存率 乳腺癌 淋巴结转移 

分 类 号：R737.905[医药卫生—肿瘤] R73-37[医药卫生—临床医学]