Ⅱ期乳腺癌的术后放疗

Postoperative radiotherapy for stage Ⅱ breast cancer

目的探讨根治术后提高肿瘤剂量及胸壁照射对Ⅱ期乳癌生存率的影响。材料与方法对比分析１９８０年１月至１９８６年底收治的Ⅱ期乳癌术后行放疗者２４８例（放疗组）与术后未行放疗者１０３例（手术组）。２４８例中ＤＴ≥５０Ｇｙ者５１例，淋巴引流区伴胸壁照射８４例。结果放疗组中ＤＴ≥５０Ｇｙ者与手术组相比，其中腋淋巴转移≥４个者的１０年生存率分别为６５．５％与３３．３％，复发率分别为６．９％与３３．３％，Ｐ＜０．０５。放疗组中淋巴引流区伴胸壁照射８４例与手术组相比，其中腋淋巴转移≥４个者的１０年生存率分别为６１．４％与３３．３％，复发率分别为４．５％与３３．３％，Ｐ＜０．０５。放疗组与手术组锁骨上区转移率分别为２．８％与７．８％，Ｐ＜０．０５。结论术后提高肿瘤剂量达５０Ｇｙ以上，并常规行胸壁放疗，可提高Ⅱ期乳癌生存率。

Purpose To study the effect of increasing radiation dose and chest wall radiation on the survival rate for stage Ⅱ breast cancer after radical operation.Materials and Methods Treatment results were compared between 248 stage Ⅱ breast cancer patients who received postoperative radiotherapy (RT) and 103 patients who received operation only (OT) from January 1980 through 1986. 51 cases received radiation doses ≥ 50Gy (HRT) and 84 cases received lymphatic drainage regions and chest wall radiation (RCT). Results The 10year survival rates and recurrence rates for patients with≥ 4 positive axillary lymph nodes in HRT group and OT group were 65.5%,33,3%(P<0.05) and 6.9%,33.3% (P<0.05),respectively. Among the patients who received the postoperative radiation of chest wall and lymphatic drainage region compare with the OT group, the 10year survival rate and recurrence rate for patients with ≥4 positive axillary lymph nodes in CRT group and OT group were 61.4%,33,3%(P<0.05) and 4.5%,33.3% (P<0.05), respectively. The recurrence rates in supraclavicular regions were 2.8% in RT group and 7.8% in OT group (P<0.05).Conclusion Increasing radiation dose to ≥50Gy and conventional chest wall radiation after operation can raise the survival rate of stage Ⅱ breast cancer.