早期乳腺癌保留乳房治疗15年的疗效观察

【作者】 朱宁生； 杨家祥； 江戈丽； 刘晓渝； 向前；

【机构】 重庆市肿瘤医院乳腺中心；

【摘要】 目的: 评价早期乳腺癌保留乳房治疗方法的远期疗效。方法:35例乳腺癌患者,年龄26—76岁,中位年龄43． 8岁。选择指征:1)肿瘤小于3cm。2)肿瘤距乳头大于3cm。 3)单发肿瘤。4)查体腋下仅有单个活动淋巴结。按AJCC乳腺癌TNM分期为I期、IIa期患者,手术的方法是肿瘤扩大切除,将肿瘤连同周围2cm正常组织一起切除,根据切缘快速病理检查结果决定是否再扩大切除术中若切缘阳性需再次扩大切除,若冰冻切缘再次阳性,且放弃保乳行改良根治术, 避免局部复发,同时清扫腋窝淋巴结组织。本组患者术后2 周伤口愈合后行乳腺切线放疗,总量46—50GY,患者瘤床采用高剂量铱192插植放疗,补加剂量12—15GY, 结合常规化疗CMF、CAF或CEF方案4—6周期,受体阳性者采用内分泌治疗(三苯氧胺)3—5年。结果:本组病例切缘均为阴性,腋下淋巴结无转移者22例,1-3枚淋巴结转移者15例。随访15年,15年局部复发率8．6％ (3／35),总生存率88．6％(31／35),美容效果满意率88． 6％(31／35)。结论:早期乳腺癌行保留乳房的治疗其1) 获得与乳腺癌根治术相同的生存率,2)术后的复发率与乳房切除相似,3)保留了乳房的外形,具有良好的美容效果,达到了高生存率、高生活质量。由于本组病例较少,有待于病例的积累,进一步研究总结。更多还原

【Abstract】 Objective: Operations for local treatment of breast cancer include breast-conserving surgery, mastectomy, and axillary lymph node sampling and removal. Modified radical mastectomy continues to be appropriate for some patients, but breast conservation therapy is now regarded as the optimal treatment for most In this study, we evaluated the long term effect on breast cancer at early stage treated with breast-conserving surgery. Methods: 35 patients with stage I and IIa breast cancer, aged 26-76 years (median age at 43.8 years), were taken breast-conserving surgery. The indications for operation included: 1) tumor size was less than 3cm, 2) distance between tumor site and nipple was more than 3 cm, 3) only single primary tumor existed, 4) only single unfixed axillary node presented. The surgical technique was that the tumor and adjacent tissue were completely removed by lumpectomy. If the surgical margin was positive on his-tological evaluation, re-excision of the biopsy site was necessary to ensure complete tumor removal. Otherwise, the conservative treatment would be given up. In addition, Standard axillary dissection was performed. The radiotherapy followed the cure of surgical incision after two weeks of operation. The dose of radiation delivered to the entire breast was between 46-50 Gy. A booster dose of 12-15 Gy was delivered to the tumor site with the insertion of iridium 192. Combining with routine chemotherapy CMF, CAF or CEF, the treatment was given for five days per week during a period of six weeks. For those whose tumor cell expressed receptor protein, the endocrinotherapy was added. Results: Histological examination demonstrated that the surrounding margin was negative in all patients and 15 patients with 1-3 positive lymph nodes were validated. The 15-years’ follow-up showed that the local recurrence rate was 8.6% (3/35), the total survival rate was 88.6% (31/35), the cosmesis and patient satisfaction was 88.6% (31/35). Conclusion: Patients diagnosed at early stages of invasive breast cancer have equivalent outcomes when they are treated by lumpectomy and radiation therapy or modified radical mastectomy. The advantage of breast-conserving surgery is that it saves the appearance of breast with the improvement in cosmesis, patient satisfaction and life quality.更多还原