5月2日，《美国医学会杂志》（JAMA）上的一项研究披露，在罹患浸润性乳腺癌并接受了肿块切除术的老年妇女中，与全乳房照射相比，近距离放射治疗与乳房长期保全可能性下降及并发症可能性的增加有关，但在总体存活率上则没有差别。
根据文章的背景资料：“近距离放射疗法是一种用一个植入性放射源来进行放疗的手段，而且它已经被用于治疗各种恶性肿瘤。近些年中，在对早期乳腺癌进行肿块切除术后施行乳腺近距离放疗已经有了大幅的增加，尽管缺乏将其与标准化全乳房照射（WBI）进行功效比较的随机化的试验数据。”
休斯敦市德克萨斯大学MD Anderson癌症中心的Grace L. Smith, M.D., Ph.D., M.P.H.及其同事们开展了一项研究，旨在比较乳腺近距离放疗 vs. WBI以及在被诊断患有浸润性乳腺癌的投保医疗保险的老年病人中乳房长期保全的可能性、并发症及存活率。这一回顾性的基于人口的研究包括了9,2735名年龄在67岁或以上的罹患浸润乳腺癌的妇女，她们是在2003至2007年间被诊断并一直随访至2008年。在肿块切除后，6952名患者接受了近距离放疗vs. 8,5783名患者接受了WBI。
研究人员发现，乳腺近距离放疗与随后的乳房切除术的较高风险有关，其5年累计发生率为3.95% vs. WBI患者的2.18%。乳房近距离放疗还与较高的感染风险及非感染性术后综合症有关；到术后1年时，接受近距离放疗的1126名患者（16.20%）经历过皮肤或软组织感染，而接受WBI的患者中出现这种情况的有8860人（10.33%）。 “类似地，到术后1年的时候，1132名接受近距离放疗的人（16.25%）经历了非感染性的术后并发症，而在接受WBI治疗的人中，这一数字为7721人（9.00%）。”
近距离放疗一般会与较高的放疗后并发症风险有关。文章的作者写道：“具体地说，5年累计性乳房疼痛的发生率在接受近距离放疗的患者中为14.55% vs. 接受WBI治疗患者的11.92%；脂肪坏死发生率为8.26% vs. 4.05%；肋骨骨折发生率为4.53% vs. 3.62%。”
文章的作者得出结论：“鉴于乳腺癌的高发病率以及近来乳腺近距离放疗应用的快速增加，这些研究发现的潜在公共卫生意义是相当大的。尽管这些结果有待在前瞻性的环境中进行验证，但它们也提示在研究的环境之外人们应谨慎对待乳房近距离放疗的广泛使用。（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.
