乳腺癌根治术后单纯胸壁复发放疗和胸壁再复发的预后分析

doi:10.3760/cma.j.cn113030-20201124-00563

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Abstract Objective To investigate the radiation field and dose selection of patients with isolated chest wall recurrence (ICWR) after modified radical mastectomy, and analyze the prognostic factors related to subsequent chest wall recurrence. Methods Clinical data of 201 patients with ICWR after mastectomy admitted to the Fifth Medical Center, Chinese PLA General Hospital from 1998 to 2018 were retrospectively analyzed. None of the patients received postoperative adjuvant radiotherapy. After ICWR, 48 patients (73.6%) underwent surgery and 155 patients (77.1%) received radiotherapy. Kaplan-Meier method was used to calculate the post-recurrence progression-free survival (PFS) rates and the difference was compared by log-rank test. Multivariate analysis was performed using Cox regression model. Competing risk model was adopted to estimate the subsequent local recurrence (sLR) rates after ICWR and the difference was compared with Gray test. Multivariate analysis was conducted using F&G analysis. Results With a median follow up of 92.8 months after ICWR, the 5-year PFS rate was 23.2%, and the 5-year sLR rate was 35.7%. Multivariate analysis showed that patients with surgery plus radiotherapy and recurrence interval oF>12 months had a lower sLR rate. Patients with recurrence interval oF>48 months, local plus systemic treatment and surgery plus radiotherapy had a higher PFS rate. Among the 155 patients who received chest wall radiotherapy after ICWR, total chest wall irradiation plus local boost could improve the 5-year PFS rate compared with total chest wall irradiation alone (34.0% vs. 15.4%, P=0.004). Chest wall radiation dose (≤60Gy vs.>60Gy) exerted no significant effect upon the sLR and PFS rates (both P>0.05). In the 53 patients without surgery, the 5-year PFS rates were 9.1% and 20.5%(P=0.061) with tumor bed dose ≤60Gy and>60Gy, respectively. Conclusions Local radiotherapy is recommended for patients with ICWR after modified radical mastectomy of breast cancer, including total chest wall radiation plus local boost. The radiation dose for recurrence should be increased to 60Gy, and it should be above 60Gy for those who have not undergone surgical resection. In addition, patients with ICWR still have a high risk of sLR, and more effective treatments need to be explored.

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	Articles by authors
	Xuan Liang
	Zhao Xuran
	Sun Huiru
	Yin Jun
	Tang Yu
	Jing Hao
	Fang Hui
	Song Yongwen
	Jin Jing
	Liu Yueping
	Ren Hua
	Chen Bo
	Qi Shunan
	Li Ning
	Tang Yuan
	Lu Ningning
	Yang Yong
	Wu Shikai
	Li Yexiong
	Wang Shulian
	Sun Bing

Key words： Breast neoplasm/modified radical mastectomy Breast neoplasm/radiotherapy Chest-wall recurrence Prognosis

Received: 24 November 2020

Fund:National Key Clinical Specialty Military Construction Project (2016)

Corresponding Authors: Sun Bing, Email:sunice116@163.com;Wang Shulian, Email:wsl20040118@yahoo.com

Cite this article:

Xuan Liang,Zhao Xuran,Sun Huiru et al. Radiotherapy for and prognosis of breast cancer patients with isolated chest wall recurrence after mastectomy[J]. Chinese Journal of Radiation Oncology, 2021, 30(9): 898-902.

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http://journal12.magtechjournal.com/Jweb_fszlx/EN/10.3760/cma.j.cn113030-20201124-00563 OR http://journal12.magtechjournal.com/Jweb_fszlx/EN/Y2021/V30/I9/898

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