5月2日，《美國醫(yī)學會雜志》（JAMA）上的一項研究披露,，在罹患浸潤性乳腺癌并接受了腫塊切除術(shù)的老年婦女中,，與全乳房照射相比，近距離放射治療與乳房長期保全可能性下降及并發(fā)癥可能性的增加有關,，但在總體存活率上則沒有差別,。
根據(jù)文章的背景資料：“近距離放射療法是一種用一個植入性放射源來進行放療的手段，而且它已經(jīng)被用于治療各種惡性腫瘤,。近些年中,，在對早期乳腺癌進行腫塊切除術(shù)后施行乳腺近距離放療已經(jīng)有了大幅的增加，盡管缺乏將其與標準化全乳房照射（WBI）進行功效比較的隨機化的試驗數(shù)據(jù),。”
休斯敦市德克薩斯大學MD Anderson癌癥中心的Grace L. Smith, M.D., Ph.D., M.P.H.及其同事們開展了一項研究,，旨在比較乳腺近距離放療 vs. WBI以及在被診斷患有浸潤性乳腺癌的投保醫(yī)療保險的老年病人中乳房長期保全的可能性、并發(fā)癥及存活率,。這一回顧性的基于人口的研究包括了9,2735名年齡在67歲或以上的罹患浸潤乳腺癌的婦女,，她們是在2003至2007年間被診斷并一直隨訪至2008年。在腫塊切除后,，6952名患者接受了近距離放療vs. 8,5783名患者接受了WBI,。
研究人員發(fā)現(xiàn)，乳腺近距離放療與隨后的乳房切除術(shù)的較高風險有關,，其5年累計發(fā)生率為3.95% vs. WBI患者的2.18%,。乳房近距離放療還與較高的感染風險及非感染性術(shù)后綜合癥有關；到術(shù)后1年時,，接受近距離放療的1126名患者（16.20%）經(jīng)歷過皮膚或軟組織感染,，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年的時候,，1132名接受近距離放療的人（16.25%）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%）,。”
近距離放療一般會與較高的放療后并發(fā)癥風險有關。文章的作者寫道：“具體地說,，5年累計性乳房疼痛的發(fā)生率在接受近距離放療的患者中為14.55% vs. 接受WBI治療患者的11.92%,；脂肪壞死發(fā)生率為8.26% vs. 4.05%,；肋骨骨折發(fā)生率為4.53% vs. 3.62%。”
文章的作者得出結(jié)論：“鑒于乳腺癌的高發(fā)病率以及近來乳腺近距離放療應用的快速增加,，這些研究發(fā)現(xiàn)的潛在公共衛(wèi)生意義是相當大的,。盡管這些結(jié)果有待在前瞻性的環(huán)境中進行驗證，但它們也提示在研究的環(huán)境之外人們應謹慎對待乳房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 Cancer
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 worse with long-term breast preservation and increased complications but no difference in survival.
