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首页> 外文期刊>Radiotherapy and oncology: Journal of the European Society for Therapeutic Radiology and Oncology >The influence of patient, tumor and treatment factors on the cosmetic results after breast-conserving therapy in the EORTC 'boost vs. no boost' trial. EORTC Radiotherapy and Breast Cancer Cooperative Groups.
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The influence of patient, tumor and treatment factors on the cosmetic results after breast-conserving therapy in the EORTC 'boost vs. no boost' trial. EORTC Radiotherapy and Breast Cancer Cooperative Groups.

机译：在EORTC“加强与无加强”试验中，患者，肿瘤和治疗因素对保乳治疗后美容结果的影响。 EORTC放射治疗和乳腺癌合作组织。

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PURPOSE: To analyze the influence of different patient, tumor, and treatment parameters on the cosmetic outcome after breast-conserving therapy at 3-year follow-up. A subjective and an objective cosmetic scoring method was used and the results of both methods were compared. PATIENTS AND METHODS: In EORTC trial 22881/10882, 5569 early-stage breast cancer patients were treated with tumorectomy and axillary dissection, followed by tangential fields irradiation of the breast to a dose of 50 Gy in 5 weeks, at 2 Gy per fraction. A total of 5318 patients, having a microscopically complete tumorectomy, were randomized between no further treatment and a boost of 16 Gy to the primary tumor bed. The cosmetic result at 3-year follow-up was assessed by a panel for 731 patients, and by digitizer measurements, measuring the displacement of the nipple, for 1141 patients. Univariate and multivariate analyses were used to evaluate the correlation between various patient, tumor, and treatment factors and cosmesis. RESULTS: The factors associated with a worsened cosmesis according to the panel evaluation were: an inferior tumor location, a large excision volume, the presence of postoperative breast complications, and the radiotherapy boost. According to the digitizer measurements, a central/superior tumor location, a large excision volume, an increased pathological tumor size, an increased radiation dose inhomogeneity, and an increased bra cup size resulted in an increased asymmetry in nipple position. It appeared that the evaluation of the nipple position (whether by panel or by digitizer) is only moderately representative of the overall cosmetic outcome. CONCLUSION: To achieve a good cosmesis, it is necessary to excise the tumor with a limited margin, to avoid postoperative complications, to assess the need for a boost in the individual patient, and to give the radiation dose as homogeneously as possible. As far as the method of evaluation is concerned, the panel evaluation is the most appropriate method for giving an overall impression of the cosmetic result after breast-conserving therapy (BCT). The use of the digitizer is recommended for comparing the cosmetic outcome of two different approaches to BCT or for analyzing cosmetic changes over time.
机译：目的：分析3年随访的保乳治疗后不同患者，肿瘤和治疗参数对美容结局的影响。使用了主观和客观的美容评分方法，并比较了两种方法的结果。患者和方法：在EORTC试验22881/10882中，对5569例早期乳腺癌患者进行了肿瘤切除术和腋窝淋巴结清扫术，随后在5周内以50 Gy的剂量对切线野进行了乳房切向照射，每部分2 Gy。共有5318名患者在显微镜下进行了完整的肿瘤切除术，在没有进一步治疗与将16 Gy增强至原发性肿瘤床之间进行随机分组。 3年随访的美容结果由731名患者组成的小组评估，并通过数字化仪测量（测量乳头的位移）评估了1141名患者。使用单因素和多因素分析来评估各种患者，肿瘤，治疗因素和美容的相关性。结果：根据专家组评估，与美容恶化相关的因素包括：肿瘤位置较差，切除量大，术后出现乳房并发症以及放疗增强。根据数字化仪的测量结果，中央/上级肿瘤位置，较大的切除体积，增大的病理肿瘤大小，增加的放射剂量不均匀性以及增大的胸罩杯大小导致乳头位置的不对称性增加。似乎对乳头位置的评估（无论是通过面板还是通过数字化仪）仅适度代表了整体美容效果。结论：为了获得良好的美容效果，有必要以有限的切缘切除肿瘤，避免术后并发症，评估对单个患者进行增强的需要，并尽可能均匀地给予放射剂量。就评估方法而言，专家组评估是在保乳治疗（BCT）后对美容效果有总体印象的最合适方法。建议使用数字化仪来比较两种不同方法的BCT外观效果，或分析随时间变化的外观变化。

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