乳腺癌根治术后辅助放疗的评价

Evaluation of the Adjuvant Post-radical-mastectomy Radiation in Breast Cancer

对乳腺癌根治术后辅助放疗的研究已多年,但意见未得一致。杭州肿瘤医院自1963年10月～1977年12月间,共有住院行根治术的女性乳腺癌1,024例,除去非浸润性癌、双侧癌或放疗疗程未完成等27例外,尚有887例,其中行术后辅助放疗285例,未放疗712例。除5例外均有随访结果,随访率为99.5％。本文拟探讨放疗对术后远期生存率的影响及其临床应用的适应症。临床资料在997例乳腺癌根治术中,术后病检腋淋巴结阴性者457例(45.8％),行辅助放疗仅36例;病检阳性者540例(54.2％),行辅助放疗249例,未放疗291例。

During 1963-1977, 997 female patients with breast cancer treated with standard Halsted radical mastectomy in Hangzhou Cancer Hospital were reviewed retrospective- ly. Of this group 285 patients were treated with adjuvant postoperative radiation, and the other 712 patients were not. The long term results of this series suggest:l. postoperative radiation did not improve the 5-and 10-year survival rates in patients with negative axillary nodes as compared with the control group, therefore, the post- operative radiation is not indicated in this group, 2. postoperative radiation slightly improved the survival rate in patients with 1-3 positive nodes, but it was not signifi- cant statistically, 3. definite improvement in survival was observed in patients with 4-6 positive nodes and 4. there was no improvement of survival rate in cases with 7 or more positive nodes, suggesting likely presence of distant metastasis. Hence, chem- otherapy may bethe first choice for postoperative adjuvant treatment.