乳腺癌根治术后辅助治疗对胸壁复发的影响(附135例分析)

The effect of postoperative adjuvant therapy on local-regional recurrence in the patients with breast cancer

目的探讨乳腺癌根治术后辅助治疗对胸壁复发的影响。方法我院 1985年 5月至1990年 5月收治Ⅱ、Ⅲ期 (TNM国际分期 )乳腺癌病人 135例 ,均行根治性手术治疗 ,其中术后辅助化疗 5 5例 ,主要为CMF方案 ,2年内完成 4～ 6疗程。术后放疗 10 9例 ,病灶同侧腋窝、锁骨上及内乳淋巴引流区DT各 4 5～ 5 5Gy/2 3～ 2 8次 /4.6～ 5 6周 ,由于放疗设备关系 ,全部病人未行术后胸壁放疗。结果随访止于 2 0 0 0年 5月 ,全组胸壁复发率 31 1% (42 /135 ) ,其中乳房原发肿瘤 >5cm及乳房原发肿瘤 2～ 5cm ,但腋淋巴结转移≥ 4个者胸壁复发率明显增高 ,乳房肿瘤外浸及二次手术治疗者亦有较高的胸壁复发率 ,术后化疗对预防胸壁复发意义不大。结论对前述高危复发病人 ,应行术后胸壁放疗 ,才能减少复发 ,提高病人生存质量。

Objective To study the effect of postoperative adjuvant therapy on local-regional recurrence in the patients with breast cancer. Methods 135 patients with breast cancer stage II～III were operated. 55 cases were applied after-chemical treatment, which were 4～6 cycles cyclophosphamide methotrexate and 5-fluorouracil (CMF) in two years. 109 cases were applied after-radial treatment, which the dose of irradiation was 45～55Gy/23～28Fx/4.6～4.8w. The radiation field included axillary supraclaricular and internal mammery regions except chest wall. Results The recurrence rate of chest wall were 31.3% (42/135) till followed-up stopped in May, 2000. The local recurrence rate was high among the patients whose the diameter of breast wall tumour was >5cm or 2～5cm with >4 positive axillary lymph nodes. Otherwise, high local recurrence rate could be observed in the patients whose surrounding tissues of breast tumour were infiltrated and who were treated with twice operation. Conclusions After-chemical treatment of breast cancer couldn't reduce the local recurrence rates. But after-radial treatment with chest wall could reduce it.