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1
題名:乳房乳管原位癌患者接受乳房保留手術合併放射線治療:預後因子分析     (18點)
DUCTAL CARCINOMA IN SITU OF THE BREAST TREATED WITH PARTIAL MASTECTOMY AND RADIATION THERAPY
著者:黃家俊(Chia-Chun Huang) ;劉幕台(Mu-Tai Liu) ;張東浩(Tung-Hao Chang) ;畢祖平(Chu-Ping Pi)
出版地區:台灣
出版城市:台北市
學科:醫學綜合
關鍵字:乳管原位癌 ; 乳癌 ; 乳房保留手術 ; 放射線治療 ; Ductal carcinoma in situ ; Breast cancer ; Partial mastectomy ; Radiation therapy
刊名:放射治療與腫瘤學
頁碼:17-25
語言:繁體中文
摘要: 中文摘要PDF ; 英文摘要PDF

且的:乳房保留手術合併放射線治療對於乳房乳管原位癌的患者來說是一個標準的治療方法。本研究的目的在分析乳房保留手術合併放射線治療,對於乳房乳管原位癌患者的治療結果,以及探討影軒頁後的因子。 拉拉血事法:從1 9 92年1 2月至20 03年7月,共有29位女性在彰化基督教醫院串底會斷為乳房的乳管原位癌,並接受乳房保留手術合併放射線治療O病人的年齡中位數是46 歲O乳房腫瘤是經由理學檢查( 1 7 % )、乳房超音波( 28 % ) ,以及乳房攝影( 55 % )所偵測到Q腫瘤的大小中位數是2 . 0公分O腫瘤大部分位於左側乳房( 66 % ) ,且以外上四分之的位置居多( 59 % )。有8位病人( 28 % )接受了服下哨兵淋巴結的切片檢查O在手術切除遺緣情況方面, 14 位病人(48%)的邊緣沒有腫瘤細胞, 6 位病人( 2 1 % )則在切除邊緣發現有殘留的腫瘤細胞G在病理報告的;欠項分要買方面, 13 位病人(45%) 是comedo type' 4 位病人(14 % )是開削的ty pe , 3 位病人( 1 0 % )是cr i b ri fo rm type ' 2 位病人(7% ) 是s ol i d type , 7 位病人(24% ) 則是沒有提到灰項分類。可0位病人( 35 % )是屬於高度惡性(川g l"可r ade )的乳管原位癌o 16 位病人( 55%)在病理報告發現有腫瘤壞死( t u mα nec r 仁尼i s )情形。患側乳房的放射線劑量中位數是46 Gy 0 腫瘤部位的加強(出os t )放射線齊置中位數是可6 Gy 0 在完瑚生射線治療的療程之後, 有1 3 位病人( 45 % ) 接受荷爾蒙治療( t a mox if en '每天20 m g) 。在統計方面, 存活率分析使用Ka p an Mei 釘, 單變項分析使用log rank test 0 結墨:這29位病人的追蹤期間從3個月至1 2 7個月不等,中位數是25個月O全部29位病人在最近一;欠的追蹤都仍然存活著Q在28位沒有任何腫瘤復發或是遠端轉移的商人中, 11 位病人存活了3 0個月以上Q其中有一位病人存活長達1 0年並且持續定期追蹤當中O在全部2 9位病人當中,只有→立( 3% ) 在追蹤7 4 . 5 年之後發現有腫瘤復發。在存活率方面, 三年與五年的整體存活率( ov e r al l surv iva l) 皆為100% 。三年與五年的無病存活率(disease-free survival )分別是100%與80% 。三年與五年的疾病相關存活率(diseas e-spec ific surv ival) 皆為100% 0 在美甚野葡意度方面, 25 位病人(86% )有優秀( ex ce ll en t )的美臨兩意度,其餘4位病人( 1 4 % )則為良好( g∞d )的美觀滿意度。以l o g ran k test 對所有變數作單變項分析之後, 發現腫瘤是否壞死( t umα n ec ros 侶, p = 0 .0455 ) ,腫瘤惡性程度( t u mα g rad e ' p = 0 .0455 ) ,手f,fcj切除邊緣是否韜爭( r 臼ection margin' p =0 .0455)' 對於無病存活率來說是重要的預後因子。 起趙:研究結果顯示,乳房保留手術合併放射梅、台療的整體存活率為1 0 0% '復發率為3% 0 預後變數當中,腫瘤是否壞死,腫瘤惡'I白雯,手術切除遺緣是否乾淨,對於無病存活率來說是重要的預後因子Q此三項因子的有無就個別比較上對病人的無病存活率在統計上有差異,至於是否為獨立( i nd epe nd ent ) 預後因子則需更多資料與讀據作多變數分析才能得知。這些分析結果可以在對於有高危險因子的乳管原位癌是否應該接受更積極的治療時,提供更多的參考資訊O未來應該要有更大型的研究與更長的追蹤時間,針對以乳房保留手術合併放射線治療的乳管原位癌病患作更進一步的分析O
Purpose : Partial mastectomy and radiation therapy is a treatment option for patients with ductal carcinoma in situ (DCIS) of breast. The aim of our study is to evaluate the outcome and analyze prognostic factors in patients with DCIS of breast treated with partial mastectomy and radiation therapy. Materials and Methods : From December 1992 through July 2003, there were 29 women diagnosed with DCIS of breast receiving the treatment of partial mastectomy and radiation therapy at our institution. The median age of diagnosis was 46 years. The median tumor size was 2.0 cm. The tumor was predominantly at left-side breast (66%), and the outer upper quadrant was the main location (59%). Sentinel axillary lymph node biopsy was performed in 8 patients (28%). The resection margin was free in 14 patients (48%), and positive in 6 patients (21%). The subtypes of pathological report were comedo type in 13 patients (45%), papillary type in 4 patients (14%), cribriform type in 3 patients (10%), solid type in 2 patients (7%), and not specified in 7 patients (24%). Ten patients had high-grade DCIS (35%). Necrosis of tumor was found in 16 patients (55%). The median radiation dose to the breast was 46Gy. The median dose of tumor bed boost was 16Gy. After completion of radiation therapy, hormone therapy with tamoxifen 10mg twice daily was administered to 13 patients (45%). Results : All 29 patients were alive until the latest follow-up. The median duration of follow-up was 25 months (range: 3 to 127 months). Among 28 patients without any regional recurrence or distant metastasis, 11 patients survived for more than 30 months. Only one out of 29 patient (3%) had regional recurrence after follow-up for 4.5 years. Three-year overall survival rate was 100%, and five-year overall survival rate was 100%. Three-year disease free survival rate was 100%, and five-year disease free survival rate was 80%. Three-year disease specific survival rate was 100%, and three-year disease specific survival rate was 100%. Twenty-five patients (86%) had excellent cosmetic results, and 4 patients (14%) had good cosmetic results. In univariate analysis of variables with log rank test, tumor necrosis, tumor grade, and resection margin were significant in predicting disease free survival. Conclusion : The good survival outcome and low local recurrence rate suggested the treatment with partial mastectomy and radiation therapy was a good option of treatment for DCIS of breast. Tumor necrosis, tumor grade, and resection margin were prognostic factors on disease free survival. Larger study series with longer follow-up period should be warranted to make advanced analysis in patients with DCIS receiving treatments of partial mastectomy and radiation therapy.


    

本卷期目次
放射治療與腫瘤學
Recurrent Pigmented Villonodular Synovitis of Knee Treated with Surgery and Adjuvant Radiotherapy: A Case Report/ Yu-Chang LiuYu-Jen ChenYung-Chang LuChang-Hung Chung
Primary Tracheal Malignancy: Our Experience / Weir-Chiang YouJian-Sheng JanJin-Ching LinYih-Chyang Weng
應用於放射治療之自動食道邊緣分割演算法 / 范佩華李宗其許靖涵
Spinal Cord Drop Metastasis of Intracranial Oligodendroglioma: A Case Report/ Shih-Tshung ChangWen-Shan Liu
鼻咽癌使用強度調控放射治療影響耳下腺功能的因子/ 劉文山蘇茂昌辛宗翰李永康周希諴郭祥吉
Concurrent Weekly Cisplatin and Radiotherapy Plus Adjuvant Chemotherapy for Nasopharyngeal Cancer –A Preliminary Study / Chien-An ChenKou-Hwa ChangYi-Shing LeuJehn-Chuan LeeYuen-Liang LaiEu-Jun ChenChang-Hung ChungYu-Jen Chen
乳房乳管原位癌患者接受乳房保留手術合併放射線治療:預後因子分析 / 黃家俊劉幕台張東浩畢祖平
Primary Central Nervous System Fibrosarcoma: Case Report and Literature Review / Forn-Chia LinJsung-Chia TsiaChang-Chuan SuChung-Ching ChioLi-Ching Lin
Primary Central Nervous System Lymphoma: A Meta-Analysis Study / Cheng-Hong LiouMu-Tai LiuShi-Hai LTung-Hao ChangChu-Ping PiChao-Yuan HuangAi-Yih WangChih-Chieh Hsu
鼻咽癌使用強度調控放射治療影響耳下腺功能的因子/ 劉文山蘇茂昌辛宗翰李永康周希諴郭祥吉
乳房乳管原位癌患者接受乳房保留手術合併放射線治療:預後因子分析/ 黃家俊劉幕台張東浩畢祖平
PRIMARY TRACHEAL MALIGNANCY: OUR EXPERIENCE/ Weir-Chiang YouJian-Sheng JanJin-Ching LinYih-Chyang Weng
PRIMARY CENTRAL NERVOUS SYSTEM LYMPHOMA: A META-ANALYSIS STUDY/ Cheng-Hong LiouMu-Tai LiuShi-Hai LiTung-Hao ChangChu-Ping PiChao-Yuan HuangAi-Yih WangChih-Chieh Hsu
應用於放射治療之自動食道邊緣分割演算法/ 范佩華李宗其許靖涵
RECURRENT PIGMENTED VILLONODULAR SYNOVITIS OF KNEE TREATED WITH SURGERY AND ADJUVANT RADIOTHERAPY: A CASE REPORT/ Yu-Chang LiuYu-Jen ChenYung-Chang LuChang-Hung Chung
PRIMARY CENTRAL NERVOUS SYSTEM FIBROSARCOMA: CASE REPORT AND LITERATURE REVIEW/ Forn-Chia LinJsung-Chia TsiaChang-Chuan SuChung-Ching ChioLi-Ching Lin
SPINAL CORD DROP METASTASIS OF INTRACRANIAL OLIGODENDROGLIOMA: A CASE REPORT/ Shih-Tshung ChangWen-Shan Liu
CONCURRENT WEEKLY CISPLATIN AND RADIOTHERAPY PLUS ADJUVANT CHEMOTHERAPY FOR NASOPHARYNGEAL CANCER-A PRELIMINARY STUDY/ Chien-An ChenKou-Hwa ChangYi-Shing LeuJehn-Chuan LeeYuen-Liang LaiEu-Jun ChenChang-Hung ChungYu-Jen Chen
 
   
 
   

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