乳腺癌根治术后单纯胸壁复发放疗和胸壁再复发的预后分析  

Radiotherapy for and prognosis of breast cancer patients with isolated chest wall recurrence after mastectomy

作　　者：宣亮 赵旭冉 孙慧茹 尹珺 唐玉 景灏 房辉 宋永文 金晶 刘跃平 任骅 陈波 亓姝楠 李宁 唐源 卢宁宁 杨勇 吴世凯 李晔雄 王淑莲 孙冰 Xuan Liang;Zhao Xuran;Sun Huiru;Yin Jun;Tang Yu;Jing Hao;Fang Hui;Song Yongwen;Jin Jing;Liu Yueping;Ren Hua;Chen Bo;Qi Shunan;Li Ning;Tang Yuan;Lu Ningning;Yang Yong;Wu Shikai;Li Yexiong;Wang Shulian;Sun Bing(Department of Radiation Oncology,the Fifth Medical Center,Chinese PLA General Hospital,Beijing 100071,China;"Department of Radiation Oncology,National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100021,China; Department of Medical Oncology,Peking University First Hospital,Beijing 100034,China)

机构地区：[1]解放军总医院第五医学中心放疗科,北京100071 [2]国家癌症中心/国家肿瘤临床医学研究中心/中国医学科学院北京协和医学院肿瘤医院放疗科,100021 [3]北京大学第一医院肿瘤化疗科,100034

出　　处：《中华放射肿瘤学杂志》2021年第9期898-902,共5页Chinese Journal of Radiation Oncology

基　　金：国家临床重点专科军队建设项目(2016)。

摘　　要：目的探究乳腺癌根治术后单纯胸壁复发(ICWR)患者的照射野及剂量选择,同时分析胸壁再复发的预后因素。方法回顾性分析1998-2018年间解放军总医院第五医学中心和医科院肿瘤医院收治的乳腺癌改良根治术后ICWR患者201例,患者术后均未行辅助放疗。胸壁复发后48例(73.6%)患者接受手术治疗,155例(77.1%)患者接受放疗。无进展生存(PFS)率的计算采用Kaplan-Meier法和log-rank检验,多因素分析采用Cox回归法。胸壁再复发的计算采用竞争风险模型和Gray检验,多因素分析采用F&G回归法。结果复发后中位随访时间92.8个月,5年PFS率为23.2%,5年胸壁再复发率为35.7%。多因素分析显示联合手术+放疗和复发间隔时间>12个月患者有较低的胸壁再复发率,复发间隔时间>48个月、联合局部+全身治疗及联合手术+放疗的患者有较高PFS率。155例患者ICWR后接受胸壁放疗,全胸壁照射+局部补量比全胸壁照射可以改善首次胸壁复发后的5年PFS率(34.0%∶15.4%,P=0.004)。胸壁放疗剂量(≤60 Gy∶>60 Gy)对胸壁再复发率及PFS率无明显影响(P>0.05)。53例未手术患者胸壁瘤床剂量≤60 Gy和>60 Gy的5年PFS率分别为9.1%和20.5%(P=0.061)。结论乳腺癌根治术后ICWR患者局部放疗建议包括全胸壁照射+局部补量,复发灶剂量需加至60 Gy,对未行手术切除者需>60 Gy。ICWR患者仍有较高的胸壁再复发风险,需要探索更有效的治疗方法。Objective To investigate the radiation field and dose selection of patients with isolated chest wall recurrence(ICWR)after modified radical mastectomy,and analyze the prognostic factors related to subsequent chest wall recurrence.Methods Clinical data of 201 patients with ICWR after mastectomy admitted to the Fifth Medical Center,Chinese PLA General Hospital from 1998 to 2018 were retrospectively analyzed.None of the patients received postoperative adjuvant radiotherapy.After ICWR,48 patients(73.6%)underwent surgery and 155 patients(77.1%)received radiotherapy-Kaplan-Meier method was used to calculate the post-recurrence progression-free survival(PFS)rates and the difference was compared by log-rank test.Multivariate analysis was performed using Cox regression model.Competing risk model was adopted to estimate the subsequent local recurrence(sLR)rates after ICWR and the difference was compared with Gray test.Multivariate analysis was conducted using F&G analysis.Results With a median follow up of 92.8 months after ICWR,the 5-year PFS rate was 23.2%,and the 5-year sLR rate was 35.7%.Multivariate analysis showed that patients with surgery plus radiotherapy and recurrence interval o F>12 months had a lower sLR rate.Patients with recurrence interval o F>48 months,local plus systemic treatment and surgery plus radiotherapy had a higher PFS rate.Among the 155 patients who received chest wall radiotherapy after ICWR,total chest wall irradiation plus local boost could improve the 5-year PFS rate compared with total chest wall irradiation alone(34.0%vs.15.4%,0.004).Chest wall radiation dose(W60 Gy vs.>60 Gy)exerted no significant effect upon the sLR and PFS rates(both P>0.05).In the 53 patients without surgery,the 5-year PFS rates were 9.1%and 20.5%(P=0.061)with tumor bed dose W60 Gy and>60 Gy,respectively.Conclusions Local radiotherapy is recommended for patients with ICWR after modified radical mastectomy of breast cancer,including total chest wall radiation plus local boost.The radiation dose for recurrence should be i

关 键 词：乳腺肿瘤/改良根治术 乳腺肿瘤/放射疗法 胸壁复发 预后 

分 类 号：R737.9[医药卫生—肿瘤]