乳腺癌乳房切除术后放射治疗的疗效分析 Efficacy of the Radiotherapy after Mastectomy in Breast Cancer

目的：总结乳腺癌乳房切除术后的放疗效果，并探讨相关预后影响因素。材料与方法：2005年1月至2012年12月共有241例入组，中位年龄51岁，最小27岁，最大75岁。0期1例，IA期11例，IIA期51例，IIB期41例，IIIA期82例，IIIB期3例，IIIC期42例，IV期10例。全组患者均接受乳房切除术，其中改良根治术210例，根治术29例，扩大根治术2例。除3例不详，其余患者均接受术后化疗，其中有50例接受新辅助化疗。全组患者均接受放射治疗，中位剂量50 Gy (30~60 Gy)，照射部位包括同侧胸壁、淋巴引流区(锁骨上和/或内乳)，147例照射同侧胸壁、锁骨上和内乳(61.0%)，47例照射胸壁和锁骨上(19.5%)，39例未照射胸壁，仅照射锁骨上和/或内乳(16.2%)，6例仅照射胸壁(2.5%)，2例照射胸壁和内乳(0.8%)。结果：中位随访5.5年(0~10年)，全组5年OS为87.5%。单因素分析显示肿瘤分期是影响OS的重要因素(P = 0.002)，I、II期的5年OS为95.9%，III、IV期的5年OS为81.0%。LRR有14例(5.8%)，DM是主要失败原因，有49例(20.3%)。死亡36例，均死于肿瘤。结论：仅5.8%的复发，提示乳房切除术后的放射治疗仍是乳腺癌术后规范治疗标准，5年OS接近国内外先进水平。 Objective: To summarize the outcome of radiotherapy in breast cancer after mastectomy, and to explore the relevant prognostic factors. Material and Methods: From January 2005 to December 2012, a total of 241 women who had undergone mastectomy were analyzed. The median age was 51 years old, with minimum 27 years old and maximum 75 years old. The pathological stage 0 were 1 case, IA of 11 cases, IIA of 51 cases, IIB of 41 cases, IIIA of 82 cases, IIIB of 3 cases, IIIC of 42 cases, IV of 10 cases, which performed in all patients by using AJCC 7th. All patients underwent mastectomy, which 210 cases of modified radical mastectomy, 29 cases of radical mastectomy, and 2 cases of extended radical mastectomy. In addition to three cases were unknown, the remaining patients received postoperative chemotherapy, while 50 patients received neoadjuvant chemotherapy. All patients were treated with radiation therapy, the median dose 50 Gy (30 - 60 Gy), irradiated sites included ipsilateral chest wall, lymph drainage area (supraclavicular and/or internal mammary). 147 cases were treated with chest wall, ipsilateral supraclavicular and internal mammary nodes irradiation (61.0%), 47 cases were treated with chest wall and supraclavicular irradiation (19.5%), 39 cases were treated with non-irradiated chest wall, only supraclavicular and/or internal mammary nodes (16.2%), 6 cases were only irradiated to chest wall (2.5%), two cases to chest wall and internal mammary irradiation (0.8%). Results: The median follow-up was 5.5 years (0 - 10 years), the 5-year OS was 87.5%. Univariate analysis showed that tumor stage was an important factor affecting the OS, 5-year OS of the pathological stage I and II was 95.9% while the OS of stage III and IV was 81.0% (P = 0.002). LRR in 14 cases (5.8%), whereas DM was the main causes of failure, which included 49 cases (20.3%). 36 patients died, all died of cancer. Conclusions Only 5.8% patients have locoregional recurrence, suggesting that radiation therapy after mastectomy is still the standard treatment in breast cancer. 5-year OS is approaching the world advanced level.