Outcomes and Prognosis of Radiation Therapy in Locoregional Recurrent Breast Cancer after Mastectomy

乳房切除術後局部復發之放射治療成果與預後

陳紘玉(Hung-Yu Chen) ； 賴俞璇(Yu-Hsuan Lai) ； 林逢嘉(Forn-Chia Lin) ； 詹凱翔(Helen H. W. Chen) ； 陳海雯(Helen H. W. Chen)

《放射治療與腫瘤學》 22卷1期 (2015/03) Pp. 1-12

https://doi.org/10.6316/TRO/201522(1)1

摘要

目的：評估乳房切除術後局部復發之乳癌病患接受放射治療的治療成果，並探討影響存活的預後因子。材料與方法：我們回顧自西元1989至2009年間，因乳房切除術後局部復發，而接受放射治療的乳癌患者之病歷，排除過去曾接受放射治療及局部復發前已有遠處轉移者，但有同步遠處轉移的患者仍納入本研究，進而分析治療成果與臨床病理之相關預後因子。使用Kaplan-Meier存活分析方法來估計局部復發無進展存活率（LRPFS）、無遠處轉移存活率（DMPFS）、和整體存活率（OS），另外使用Cox比例風險模式，來評估這些臨床病理參數的預後意義。結果：155位病患被納入本研究，追蹤時間中位數為9.8年。31位（20%）患者在局部復發診斷時有同步遠處轉移，而124位（80%）患者則僅有局部復發而無遠處轉移。有同步遠處轉移患者和無遠處轉移患者的OS中位數，分別為1.6和4.2年間（P= 0.001），但兩組間的LRPFS無差異（P= 0.33）。對其中124例無遠處轉移的患者，5年的LRPFS，DMFS和OS分別為：58.9%，35.4%和46%，且後續有83位（67%）病人發生癌症遠端轉移。胸壁復發的患者有顯著較好的存活，比孤立淋巴腺復發或多個部位復發者好（五年存活率為56.3% vs. 39.8% vs. 27.8%，P=0.04）。對這群無遠處轉移的患者，多變數分析顯示，局部復發的部位和腫瘤的最初分期是影響LRPFS的顯著預後因子；而積極的局部治療（包括手術和放射治療）、腫瘤的最初分期和挽救性全身治療是影響OS的顯著預後因子。結論：局部復發乳癌有高風險易遠處轉移，積極的局部治療和全身性治療可以讓部份比例的患者達到長期的存活。

關鍵字

放射治療 ； 乳癌 ； 局部復發 ； 預後

並列摘要

Purpose: To analyze the treatment outcomes of radiation therapy (RT) in breast cancer patients who developed locoregional recurrence (LRR) after initial treatment with mastectomy, and to investigate the prognostic factors influencing survival. Materials and Methods: We retrospectively reviewed medical records of breast cancer patients who received RT for post-mastectomy LRR in our hospital from 1989 to 2009. Patients who had previous RT and distant metastasis before LRR were excluded, but patients with synchronous distant metastasis were included in this study. Clinicopathologic parameters and outcomes were analyzed. Kaplan-Meier method was used to estimate local recurrence progression-free survival (LRPFS), distant metastasis -free survival (DMFS) and overall survival (OS). Cox proportional hazards models were utilized to assess the prognostic significance of these clinicopathologic parameters on survival. Results: One hundred and fifty-five patients were included in the study. Median followup time was 9.8 years. Thirty-one (20.0%) patients had synchronous metastasis at the diagnosis of LRR, while 124 (80%) patients had not. The median OS for patients with and without synchronous metastasis were 1.6 and 4.2 years, respectively (P= 0.001), but there was no difference on LRPFS between these two groups (P= 0.33). Among the 124 patients without synchronous metastasis, the 5-year LRPFS, DMFS and OS for were 58.9%, 35.4% and 46%, respectively. Eighty-three patients (67%) subsequently developed distant metastases. Patients with chest wall recurrence had a significantly better 5-year OS than patients with isolated LN or multiple sites recurrences (56.3% vs. 39.8% vs. 27.8%, P= 0.04). Multivariate analysis for patients without synchronous metastasis revealed that sites of LRR and initial stage were significant prognostic factors for LRPFS, while aggressive local therapy (including surgery and RT), initial stage and salvage systemic therapy were significant prognostic factors affecting OS. Conclusions: Locoregional recurrent breast cancer carries a high risk of distant metastasis. Use of aggressive local therapy and systemic therapy can achieve good survival outcomes in a substantial proportion of patients.

並列關鍵字

Radiation therapy ； Breast neoplasms ； Locoregional recurrence ； Prognosis