- 期刊
Outcome of Salvage Irradiation for Breast Cancer Patients with Locoregional Recurrence
局部復發之乳房腫瘤病患接受放射線治療的成果
摘要
Purpose: This study aimed to investigate the outcome of salvage radiotherapy for post-mastectomy breast cancer patients with locoregional recurrence (LRR). Materials and Methods: This study comprised 63 patients who completed allocated radiation treatment for LRR after mastectomy from October 1989 to December 2000. The distribution of initial American Joint Committee on Cancer (AJCC) 6th staging, 2002, included 4 stage I patients, 8 stage ha patients, 22 stage IIb patients, 23 stage IIIa patients, and 6 stage IIIb patients. The recurrent sites (including 40 in the ipsilateral chest wall, 16 in the axillary fossa, and 22 in the supraclavicular fossa) were treated with either electron beam or combined photon-electron beam therapy. The median prescribed dose was 60 Gy (range, 40-66 Gy). The overall survival (OS), disease free survival (DFS), locoregional free survival (LRFS), and distant metastasis free survival (DMFS) rates were compared by Kaplan-Meier method (Log-rank test); Cox regression model was used for a multivariate analysis. Results: After a median follow-up of 36 months (range, 3-93 months), 35 patients (55.6%) had developed distant metastasis at the time of the most recent follow-up. The most common sites were lung (41.7%) and bone (44.4%). The 3-year OS rate was 54%. The overall 3-year DFS rate was 31.7%. The overall 3-year LRFS rate was 50.8%. The overall 3-year DMFS rate was 34.9%. The 3-year OS for single site and multiple site recurrence was 60.4% and 20% (p=0.02), while the 3-year OS for small recurrent tumor (＜=3cm) and large tumor/multiple lesions was 71.9% and 35.5%, respectively (p＜0.01). Analysis of initial nodal status revealed that the 3-year OS for patients with no node metastasis was 78.6% and that for patients with positive node metastasis was 46.9% (p=0.04). In addition, the 3-year OS for patients with long latent period (＞24 months) and short latent period was 81.5% and 33.3% (p＜0.01), respectively. The 3-year OS for patients with and without surgery for recurrent tumor was 63.8% and 25% (p＜0.01), respectively. Conclusion: Salvage radiotherapy is effective in achieving satisfactory local control in patients with early stage disease and no lymph node metastasis who developed LRR. For patients with multiple or large recurrent tumors, as well as advanced initial lymph node metastasis, it is imperative to incorporate more aggressive systemic treatment to improve treatment outcome.
並列摘要
Purpose: This study aimed to investigate the outcome of salvage radiotherapy for post-mastectomy breast cancer patients with locoregional recurrence (LRR). Materials and Methods: This study comprised 63 patients who completed allocated radiation treatment for LRR after mastectomy from October 1989 to December 2000. The distribution of initial American Joint Committee on Cancer (AJCC) 6th staging, 2002, included 4 stage I patients, 8 stage ha patients, 22 stage IIb patients, 23 stage IIIa patients, and 6 stage IIIb patients. The recurrent sites (including 40 in the ipsilateral chest wall, 16 in the axillary fossa, and 22 in the supraclavicular fossa) were treated with either electron beam or combined photon-electron beam therapy. The median prescribed dose was 60 Gy (range, 40-66 Gy). The overall survival (OS), disease free survival (DFS), locoregional free survival (LRFS), and distant metastasis free survival (DMFS) rates were compared by Kaplan-Meier method (Log-rank test); Cox regression model was used for a multivariate analysis. Results: After a median follow-up of 36 months (range, 3-93 months), 35 patients (55.6%) had developed distant metastasis at the time of the most recent follow-up. The most common sites were lung (41.7%) and bone (44.4%). The 3-year OS rate was 54%. The overall 3-year DFS rate was 31.7%. The overall 3-year LRFS rate was 50.8%. The overall 3-year DMFS rate was 34.9%. The 3-year OS for single site and multiple site recurrence was 60.4% and 20% (p=0.02), while the 3-year OS for small recurrent tumor (＜=3cm) and large tumor/multiple lesions was 71.9% and 35.5%, respectively (p＜0.01). Analysis of initial nodal status revealed that the 3-year OS for patients with no node metastasis was 78.6% and that for patients with positive node metastasis was 46.9% (p=0.04). In addition, the 3-year OS for patients with long latent period (＞24 months) and short latent period was 81.5% and 33.3% (p＜0.01), respectively. The 3-year OS for patients with and without surgery for recurrent tumor was 63.8% and 25% (p＜0.01), respectively. Conclusion: Salvage radiotherapy is effective in achieving satisfactory local control in patients with early stage disease and no lymph node metastasis who developed LRR. For patients with multiple or large recurrent tumors, as well as advanced initial lymph node metastasis, it is imperative to incorporate more aggressive systemic treatment to improve treatment outcome.