5月2日,，刊登在《美國(guó)醫(yī)學(xué)會(huì)雜志》（Journal of American Medical Association）上的一項(xiàng)研究披露，在罹患浸潤(rùn)性乳腺癌并接受了腫塊切除手術(shù)的老年婦女中,，與全乳房照射（WBI）相比,，近距離放射治療可能導(dǎo)致手術(shù)后并發(fā)癥的增加,，以及乳房長(zhǎng)期保全的可能性下降,，但兩者在總體存活率上并沒(méi)有差別,。
近距離放射療法是一種用一個(gè)植入性放射源來(lái)進(jìn)行放療的手段，而且它已經(jīng)被用于治療各種惡性腫瘤,。在近些年中,，早期乳腺癌進(jìn)行腫塊切除術(shù)后施行乳腺近距離放療的人數(shù)已經(jīng)有了大幅的增加,，盡管還缺乏將其與標(biāo)準(zhǔn)化的WBI的功效比較的隨機(jī)試驗(yàn)數(shù)據(jù)。
休斯敦市得克薩斯大學(xué)MD Anderson癌癥中心博士Grace L. Smith及其同事們開展了一項(xiàng)研究,，旨在比較近距離放療與WBI兩種方式對(duì)術(shù)后中老年病人的并發(fā)癥,、乳房長(zhǎng)期保全的可能性及存活率的效果,。這一研究包括了92735名年齡在67歲或以上的婦女，她們?cè)?003~2007年間被診斷出患有乳腺癌,，并一直隨訪至2008年,。在腫塊切除后,，6952名患者接受了近距離放療,，85783名患者接受了WBI,。
研究人員發(fā)現(xiàn),，近距離放療可能增加感染風(fēng)險(xiǎn)及非感染性術(shù)后綜合征的發(fā)病幾率,。到術(shù)后1年時(shí),，接受近距離放療的1126名（16.20%）患者曾有皮膚或軟組織感染，而接受WBI的患者中出現(xiàn)這種情況的有8860人（10.33%）,。 “類似地,，到術(shù)后1年的時(shí)候，1132名（16.25%）接受近距離放療的人經(jīng)歷了非感染性的術(shù)后并發(fā)癥,，而在接受WBI治療的人中,，這一數(shù)字為7721人（9.00%）。”Smith指出,。
最后,，研究人員得出結(jié)論：“鑒于乳腺癌的高發(fā)病率以及近來(lái)乳腺近距離放療應(yīng)用人數(shù)的快速增加，這些研究發(fā)現(xiàn)有相當(dāng)大的潛在公共衛(wèi)生意義,。盡管這些結(jié)果還有待在其他環(huán)境中進(jìn)行驗(yàn)證,，但它們也提示在研究環(huán)境之外，人們應(yīng)謹(jǐn)慎對(duì)待乳腺近距離放療的廣泛使用,。”（生物谷Bioon.com）
doi:10.1001/jama.2012.3481
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Association Between Treatment With Brachytherapy vs Whole-Breast Irradiation and Subsequent Mastectomy, Complications, and Survival Among Older Women With Invasive Breast CancerBrachytherapy vs Whole Breast Irradiation
Grace L. Smith, MD, PhD, MPH; Ying Xu, MD, MS; Thomas A. Buchholz, MD; Sharon H. Giordano, MD, MPH; Jing Jiang, MS; Ya-Chen Tina Shih, PhD; Benjamin D. Smith, MD
Context Brachytherapy is a radiation treatment that uses an implanted radioactive source. In recent years, use of breast brachytherapy after lumpectomy for early breast cancer has increased substantially despite a lack of randomized trial data comparing its effectiveness with standard whole-breast irradiation (WBI). Because results of long-term randomized trials will not be reported for years, detailed analysis of clinical outcomes in a nonrandomized setting is warranted. Objective To compare the likelihood of breast preservation, complications, and survival for brachytherapy vs WBI among a nationwide cohort of older women with breast cancer with fee-for-service Medicare. Design Retrospective population-based cohort study of 92 735 women aged 67 years or older with incident invasive breast cancer, diagnosed between 2003 and 2007 and followed up through 2008. After lumpectomy 6952 patients were treated with brachytherapy vs 85 783 with WBI. Main Outcome Measures Cumulative incidence and adjusted risk of subsequent mastectomy (an indicator of failure to preserve the breast) and death were compared using the log-rank test and proportional hazards models. Odds of postoperative infectious and noninfectious complications within 1 year were compared using the χ2 test and logistic models. Cumulative incidences of long-term complications were compared using the log-rank test. Results Five-year incidence of subsequent mastectomy was higher in women treated with brachytherapy (3.95%; 95% CI, 3.19%-4.88%) vs WBI (2.18%; 95% CI, 2.04%-2.33%; P < .001) and persisted after multivariate adjustment (hazard ratio [HR], 2.19; 95% CI, 1.84-2.61, P < .001). Brachytherapy was associated with more frequent infectious (16.20%; 95% CI, 15.34%-17.08% vs 10.33%; 95% CI, 10.13%-10.53%; P < .001; adjusted odds ratio [OR], 1.76; 1.64-1.88) and noninfectious (16.25%; 95% CI, 15.39%-17.14% vs 9.00%; 95% CI, 8.81%-9.19%; P < .001; adjusted OR, 2.03; 95% CI, 1.89-2.17) postoperative complications; and higher 5-year incidence of breast pain (14.55%, 95% CI, 13.39%-15.80% vs 11.92%; 95% CI, 11.63%-12.21%), fat necrosis (8.26%; 95% CI, 7.27-9.38 vs 4.05%; 95% CI, 3.87%-4.24%), and rib fracture (4.53%; 95% CI, 3.63%-5.64% vs 3.62%; 95% CI, 3.44%-3.82%; P ≤ .01 for all). Five-year overall survival was 87.66% (95% CI, 85.94%-89.18%) in patients treated with brachytherapy vs 87.04% (95% CI, 86.69%-87.39%) in patients treated with WBI (adjusted HR, 0.94; 95% CI, 0.84-1.05; P = .26). Conclusion In a cohort of older women with breast cancer, treatment with brachytherapy compared with WBI was associated with worse long-term breast preservation and increased complications but no difference in survival.
