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目的:探讨乳腺癌术后局部区域复发的规律和再放疗的预后。方法:回顾分析45例Ⅰ期、Ⅱ期乳腺癌术后局部区域复发的情况以及复发后放疗的预后。26例采用局部野放疗,19例采用扩大野放疗。结果:T2及腋窝淋巴结转移数≥4枚或≥20 %的病例占复发病例的73 %。复发的部位依次为锁骨上、多部位、胸壁、腋窝、内乳。复发后2 a生存率40 %、无瘤生存率24.4 %,2次局部区域复发率31 %,术后2 a以上复发的2 a生存率64 %,2 a以下29 %。首次复发累及多部位生存率18.2 %,较单一锁骨上(47.4 %)及胸壁(30 %)低,累及锁骨上局部复发率高于胸壁,远处转移率低于胸壁,2次局部复发胸壁最高达57 %,照射野采用广泛野的局部复发率低于采用局部野。结论:对Ⅰ期、Ⅱ期乳腺癌中腋窝淋巴结阳性≥4枚或≥20 %的病例应常规行术后放疗,对术后局部区域复发的病例应采用包括胸壁及锁骨上下大范围照射。
Objective: To investigate the rule of local recurrence after breast cancer and the prognosis of reradiation. Methods: Retrospective analysis of 45 cases of stage Ⅰ, Ⅱ breast cancer recurrence after local regional recurrence and prognosis of radiotherapy. Twenty-six patients received local field radiotherapy and 19 patients received extended radiotherapy. Results: T2 and axillary lymph node metastases ≥ 4 or ≥ 20% of the cases accounted for 73% of the recurrence cases. Recurrence of the site followed by the supraclavicular, multi-site, chest wall, armpit, lactation. The survival rate was 40% at 2 years after recurrence, 24.4% at tumor-free survival, 31% at second local recurrence, 64% at 2 years and 29% at 2 years after recurrence. The first recurrence involved multi-site survival rate of 18.2%, which was lower than that of single supraclavicular (47.4%) and chest wall (30%). The local recurrence rate was higher in the clavicle than that in the chest wall. The distant metastasis rate was lower than that in the chest wall. Up to 57%, the radiation field using a wide field of local recurrence rate is lower than the use of local field. CONCLUSIONS: Radiotherapy should be routinely performed in patients with stage Ⅰ and stage Ⅱ breast cancer who have positive axillary lymph nodes≥4 or ≥20%. Patients with recurrence in the local area should be treated with a large area of upper and lower chest wall and clavicle.