早期乳腺癌保留乳房治疗的临床研究

Clinical study of breast-conserving treatment for early-stage breast cancer

目的 探讨早期乳腺癌保留乳房治疗的可行性及安全性。方法 回顾性分析 40例早期乳腺癌病例接受保留乳房治疗的疗效。治疗方法采用乳腺肿块局部切除及同侧腋窝淋巴结清扫 ,术后行同侧全乳、相邻胸壁、腋窝、锁骨上下淋巴结区域外照射放射治疗 ,部分病例照射了内乳区 ,外照射剂量 45～ 5 0Gy ,2 3～ 2 5次。乳房肿瘤的局部补量照射采用高剂量率 (HDR) 192 Ir进行组织间插植补量照射或 9～ 12MeV电子束局部照射 ,剂量 12～ 2 0Gy。结果 全组 5、10年无瘤生存率和总生存率分别为 90 .0 %、82 .2 9%和 92 .5 %、87.3 6% ,10年局部复发率 5 .0 7% ,10年远地转移率 5 % ,Ⅰ、Ⅱ期10年生存率的统计学差异有显著性意义 ,χ2 =17.5 1,P <0 .0 0 1。HDR192 Ir组织间插植补量照射与电子束补量照射和腋淋巴结阴性病例与腋淋巴结阳性病例的 5、10年生存率的统计学差异无显著性意义。Cox模型多因素预后分析显示临床分期具有影响预后的趋势 ,其Ⅰ、Ⅱ期的相对危险度是 2 .73 8倍。全组美容效果达到等级佳和良的占 92 .5 %。结论 早期乳腺癌保留乳房治疗安全可靠 ,但对Ⅱ期病例应慎重对待。

Objective To evaluate the feasibility and security of breast-conserving treatment for the early-stage breast cancer.Methods Retrospective evaluate the efficacy of breast-conserving treatment for the 40 cases of the early-stage breast cancer patients.All the patients underwent lumpectomy and axillary dissection followed by ipsilateral whole breast,chest-wall,axilla,supraclavicula lymph node region irradiation of 45～50 Gy for 23～25 times.All the patients received 12～20Gy in local region with HDR 192 Ir brachytherapy or 9～12MeV electron external irradiation.Results The 5-years and 10-years overall survival rate of the entire group was 92.5% and 87.36% with a corresponding disease-free survival rate of 90.0% and 82.29%,respectively.The 10 years local-regional failure rate for the entire group was 5.07%,with a corresponding metastasis rate was 5%.There was a significant statistical difference found in the 10 years survival rate of pathologic Stage Ⅰ and Ⅱ patients(χ 2=17.51,P<0.001).No significant statistical differences were found in the 5 and 10-years survival rate of the negative and positive axillary lymph nodes patients,and also in the patients receiving boost with HDR 192 It interstitial brachytherapy and electron external irradiation.The analysis of Cox model multifactor show that clinical stage is a factor which may affect prognosis(β=2.738),its relative dangerness of stage Ⅰ and Ⅱ is 2.738 times.92.5%of the entire group reached the fine and good cosmetic effect.Conclusion The breast-conserving treatment of early-stage breast cancer is the safe and reliable therapy,but the cases of stage Ⅱ should be handled with great care.