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首页> 外文期刊>International Journal of Radiation Oncology, Biology, Physics >Does axillary boost increase lymphedema compared with supraclavicular radiation alone after breast conservation?
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Does axillary boost increase lymphedema compared with supraclavicular radiation alone after breast conservation?

机译：保留乳房后，与单纯锁骨上放疗相比，腋窝增强疗法是否会增加淋巴水肿？

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PURPOSE: To determine independent predictors of lymphedema (LE) after breast radiotherapy and to quantify added risks of LE from regional node irradiation (RNI). MATERIALS AND METHODS: A total of 2,579 women with T1-2, N 0-3, M0 breast cancer treated with breast conservation between 1970 and 2005 were studied. A total of 2,169 patients (84%) received radiation to the breast (B), 226 (8.8%) to the breast and supraclavicular LNs (B+SC), and 184 (7.1%) to the breast, supraclavicular LNs, and a posterior axillary boost (B+SC+PAB). Median follow-up was 81 months (range, 3-271). RESULTS: Eighteen percent of patients developed LE. LE risks were as follows: 16% (B), 23% (B+SC), and 31% (B+SC+PAB) (p < 0.0001). LE severity was greater in patients who had RNI (p = 0.0002). On multivariate analysis, RT field (p < 0.0001), obesity index (p = 0.0157), systemic therapy (p = 0.0013), and number of LNs dissected (p < 0.0001) independently predicted for LE. In N1 patients, the addition of a SC to tangents (p < 0.0001) and the addition of a PAB to tangents (p = 0.0017) conferred greater risks of LE, but adding a PAB to B+SC RT did not (p = 0.8002). In the N2 patients, adding a PAB increased the risk of LE 4.5-fold over B+SC RT (p = 0.0011). CONCLUSIONS: LE predictors included number of LNs dissected, RNI, obesity index, and systemic therapy. LE risk increased when a SC or PAB were added in the N1 subgroup. In the N2 patients, a PAB increased the risk over B+SC. The decision to boost the axilla must be weighed against the increased risk of LE that it imposes.
机译：目的：确定乳腺癌放疗后淋巴水肿（LE）的独立预测因子，并量化区域淋巴结照射（RNI）导致LE的附加风险。材料与方法：研究了1970年至2005年间共2579例经保乳治疗的T1-2，N 0-3，M0乳腺癌妇女。共有2169例患者（84％）接受了对乳房（B）的放射，226例（8.8％）的对乳房和锁骨上LN（B + SC）的放射，以及184例（7.1％）的乳腺，锁骨上的LN和放射后腋增强（B + SC + PAB）。中位随访时间为81个月（范围3-271）。结果：18％的患者发展为LE。 LE风险如下：16％（B），23％（B + SC）和31％（B + SC + PAB）（p <0.0001）。患有RNI的患者的LE严重程度更高（p = 0.0002）。在多变量分析中，独立预测了LE的RT视野（p <0.0001），肥胖指数（p = 0.0157），全身治疗（p = 0.0013）和解剖的LN数量（p <0.0001）。在N1例患者中，在切线中添加SC（p <0.0001），在切线中添加PAB（p = 0.0017）会增加发生LE的风险，但在B + SC RT中添加PAB却没有（P = 0.8002） ）。在N2病人中，添加PAB可使LE的风险比B + SC RT高4.5倍（p = 0.0011）。结论：LE预测因素包括解剖的LN数量，RNI，肥胖指数和全身治疗。在N1亚组中添加SC或PAB会增加LE风险。在N2患者中，PAB的风险高于B + SC。增强腋窝的决定必须权衡其施加的LE风险的增加。

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