乳腺癌根治术后区域淋巴结复发放射治疗疗效分析

Radiotherapeutic management of regional lymph nodes recurrence following mastectomy

目的 :探讨乳腺癌根治术后区域淋巴结复发患者放射治疗和其他综合治疗手段的合理联用以及影响局部控制率和生存率的预后因素。方法 :回顾性分析了 1994～ 2 0 0 3年期间在我院放疗科收治的 77例乳腺癌根治术后区域淋巴结复发作为术后第一次治疗失败的患者 ,其中 4 5例为锁骨上淋巴结 ,16例腋下淋巴结 ,6例内乳淋巴结 ,10例同时有 2个淋巴结区累及。中位随访时间为 34.4个月。所有患者均接受放射治疗。 12例在放疗前接受复发灶手术切除。照射剂量范围为 5 0～ 74Gy ,中位剂量为 6 0Gy。 结果 :本组患者中位生存期为 4 .6 7年 ,二年、五年和八年生存率分别为 77.8%、4 7.4 %和 31.5 %。无病间期、激素受体状态为影响生存率的独立的预后因素。总计有 30例 (39% )发生再次局部和 (或 )区域性复发 ,其中 4例发生在原复发部位 ,2 6例发生在其他部位 ,胸壁是发生率最高的二次复发部位 ,总计有 18例 (2 3% )患者发生的再次复发部位中包括胸壁。首次术后病理腋淋巴结转移数目是影响局部控制率的预后因素。结论 :放射治疗是乳腺癌术后区域淋巴结复发的有效治疗手段。 2 3%的患者治疗后发生后续的胸壁复发 ,建议对患侧胸壁作预防性照射。首次术后病理腋淋巴结转移数目 4个及以上的患者作胸壁预防的意义更大。

Purpose:To investigate the prognostic factors f or local-regional control and survival in patients with regional lymph nodes re currence following mastectomy. Methods:Seventy-seven patients with their first recurrences in the regional lymph nodes treated during 1994-2003 were retrospectively analyze d. The recurrence were confined to supraclavicular region in 45 patients, in axi llary nodes in 16 patients, in internal mammary nodes in 6 patients, and with mo re than one lymph node region involved in 10 patients. The median follow-up was 34.4months. All patients were treated with radiotherapy to a total dose ranged from 50-74 Gy with a median dose of 60 Gy. Results:The median survival time was 4.67 years with 2-,5-an d 8- year survival rate of 77.8%,47.4% and 31.5% respectively. Disease-free i nterval, hormonal-receptor status were independent prognostic factors for survi val. Thirty patients had a second recurrence either in the original recurrent si te (4 patients) or in the other local-regional sites (26 patients). Chest-wall was the most frequently involved site for second recurrence, with 18 patients h ad a second recurrence including chest-wall, representing 23% of the whole coho rt. The axillary lymph nodes metastatic status of primary surgery was the only i ndependent prognostic factor for local control. Conclusions:Radiotherapy provides an efficient treatment for re gional lymph nodes recurrence following mastectomy. Twenty-three percent of pat ients present a second recurrence involving chest-wall, which suggests the sign ificance of an elective radiation to the chest-wall, especially in patients wit h 4 or more lymph nodes involved in primary surgery. Sub-group with a disease- free interval of more than 2 years, receptor positive has a better survival. The role of systemic treatment in the regional lymph nodes recurrent patients has n ot been established.