Analysis The Postoperative Radiotherapy And Prognostic Factors For T1-2N1M0Breast Cancer

Objective:To provide reference for selecting the treat schedule of T1-2N1M0in breast cancer, which is through studing the efficacy of radiotherapy and the prognosis factors.Methods:A retrospective of T1-2N1M0breast cancer analysed with complete medical records from January2004to January2008in the first affiliated hospital of dalian medicial university,whose pathology check were confirmed by modified radical mastectomy. The bound of the radiation field including the affected side of the chest wall and supraclavicular lymph node regions:that include clavicular head for the upper bound of chest wall,contralateral breast folds under2cm for the lower, the body midline for the inner, the anterior axillary line or the axillary line for the outbound which can package the whole scars and drainage mouth. We give the chest wall prescribed dose of6MeV electron lines, At the beginning10-15F,use tissue compensator material, and2Gy per time,5times per week, the total dose were50Gy per25times. The bound of the clavicle Ueno:upper bound of the level of the cricoid cartilage, the sternocleidomastoid edge within0.5-lcm for the inner, the humeral head for the lateral which can Package the supraclavicular lymph node drainage area. The prescribed dosage:6MV-X line+9MeV/12MeV-electronic line,50Gy in total. All patients using the CAF (cyclophosphamide, doxorubicin, fluorouracil)/CEF (cyclophosphamide, epirubicin the Star+fluorouracil) program or AC-T (doxorubicin+cyclophosphamide-docetaxel) chemotherapy for4to8cycles, which are for the sequential radiotherapy or sandwich applications. Patients would receive endocrine therapy in using of tamoxifen or an aromatase inhibitor treatment for whom the ER and (or) PR were positive,and the average treatment time is48months (11-60months). A review of the medical records, patient room or telephone patients and their families to obtain the follow-up data. The follow-up time was started at the surgery date and end in March15,2013or died or loss of time. Meet the inclusion criteria of patients with a total of161cases, of which12patients were lost. The final analysis of the number were149cases, follow-up rate at92.5%. The median follow-up time was87months (13-122months). There were87patients with radiotherapy, while others without. Though the comparison we found that there had no significant difference between the two groups in patients’age, tumor stage, lymph node-positive rate, menstruation, postoperative pathology, adjuvant chemotherapy, adjuvant endocrine therapy.In this study, we apply the SPSS19.0software for statistical analysis. Cox regression model using the Kaplan-Meier method and the log-rank test, to calculate overall survival and disease-free survival, and multivariate analysis using backward stepwise method, and X2to test the rest rates. P <0.05was considered statistically significant.Results:1.At the end of the follow-up time,25cases were occurred in local recurrence and distant metastasis and12cases died in the whole group of149patients, The5-year survival rate with not radiotherapy and radiotherapy cases were91.9%and96.6%, no significant difference (x2=1.465, P=0.226). but not radiotherapy and radiotherapy cases of progression-free survival rates were74.2%and88.5%(x2=13.05, P <0.001), distant metastasis rates were19.3%and10.3%(x2=4.327, P0.038), local recurrence rates were6.45%and1.15%(x2=4.212, P=0.040). Radiotherapy can prolong progression-free survival (DFS) and reduce the rate of distant metastasis and local recurrence.2.The Cox prognostic model for Univariate analysis shows that postoperative radiotherapy and menstrual status are notable factors in affecting progression-free survival (DFS). While age and menopausal status are significant to overall survival (OS) in affecting breast cancer.3.The Cox multi-factor model for multivariate analysis in prognostic Shows: postoperative radiotherapy, menstrual status are the independent prognostic factors for DFS. While age, histological type, lymph node-positive rate, the maximum diameter of the tumor, ER, PR, Her-2have no significant effect in progression-free survival time (DFS)Conclusion:1.There have no significante effect on the5-year survival rate for T1-2N1M0breast cancer patients whether they do radiotherapy post modified radical operation, but it has significant in improving progression-free survival, reducing the rate of distant metastasis and local recurrence when do postoperative radiotherapy.2.Age, menstrual status are significante factors to affect the overall survival time of patients with breast cancer, and age>60years\postmenopausal can survive longer.3. Menstrual status and radiation are the independent prognostic factor in affecting progression-free survival (DFS), and postoperative radiotherapy can extend the pre-menopausal patients with DFS, and for the T1-2N1M0premenopausal patients we suggest for postoperative radiotherapy.4. In this study, This is a retrospective analysis, the cases selected is not randomed, the follow-up time is short,so there need to continue to strengthen the follow-up, expand the sample size to provide more evidence for our experimental results.