2012年10月28-31日，第54届美国放射肿瘤学会（ASTRO）年会在美国波士顿举行。来自世界各地的放射肿瘤学领域的医生及相关人士共计11000多人参会。本届年会的主题是“通过创新改善患者治疗（Advancing Patient Care through Innovation）”。 对本届年会进行了专题报道（http://zt.cmt.com.cn/zt/astro2012/index.html），敬请关注！

　　会上，美国学者报告了一项研究：Prognostic Outcomes of Local-regional Recurrence in Breast Cancer Patients Treated by Breast-conservation Treatment ，其摘要如下：

Purpose/Objective(s)
Evaluate the prognostic outcome of local-Regional Recurrence in breast cancer patients treated by breast conservative surgery and radiation therapy (BCS + RT).

Materials/Methods
Between January 1980 and December 2010, 2623 breast cancer patients, underwent BCS + RT. One hundred fifty-one patients developed 168 Local-Regional Recurrences (LRR) as their first site of failure. This group of patients served as the base of our study. Recurrences were distributed as follows: 72 breast true recurrence (same site), 42 breast elsewhere recurrence, 19 axillary, 9 IMC, 15 supra-clavicular, and 11 chest wall recurrences. These patients were managed as follows; 110 patients underwent surgery (excision/ mastectomy), 69 received systemic therapy (chemo-/hormonotherapy/trastuzumab), and 19 received radiation therapy alone. A univariate and multivariate analysis were performed using the Kaplan-Meier method and Cox model (SAS/STAT 9.2) with the following variables: interval in months between diagnosis of original tumor and LRR event (INT), other types of recurrences (other than in-breast), multiple LRR and treatment by surgery/systemic therapy/radiation therapy.

Results
The average follow-up after local failure was 73 +/- 5.7 months, median 50 months. The average INT was 80.2 +/- 5 months, median 64 months. The overall survival rate was 65.5% (95% CI: 56.5% - 73.1%) at 5 years and 55.7% (95% CI: 45.7% - 64.5%) at 10 years. The distant recurrence rate for isolated LLR (119 pts) was 20.2% (95% CI: 13.5% - 29.7%) at 5 years and the same rate at 10 years. A multivariate analysis was performed for: Overall survival rate: (1) INT (p = 0.019): HR = 0.992 (95% CI: from 0.984 to 0.998), (2) Other recurrence: (p = 0.0001): HR = 4.60 (95% CI: from 2.08 to 9.9), (3) Surgery: (p = 0.0075): HR = 0.27 (95% CI: from 0.10 to 0.68), (4) Multiple LRR (p = 0.42): HR = 1.31 (95% CI: from 0.65 to 2.45) (5) Systemic therapy (p = 0.062): HR = 0.45 (95% CI: from 0.184 to 0.995), and (6) Radiation therapy (p = 0.25): HR = 0.590 (95% CI: from 0.23 to 1.39). Distant Recurrence Rate: (1) INT (p = 0.030): HR = 0.986 (95% CI: from 0.973 to 0.998), (2) Other recurrence (p = 0.025): HR = 4.12 (95% CI: from 1.14 to 13.83) (3) Surgery: (p = 0.095): HR = 0.22 (95% CI: from 0.03 to 1.17), (4) Multiple LRR (p = 0.58): HR = 1.36 (95% CI: from 0.39 to 3.85), (5) Systemic therapy (p = 0.21): HR = 0.38 (95% CI: from 0.06 to 1.39), and (6) Radiation therapy (p = 0.39): HR = 0.56 (95% CI: from 0.13 to 2.05).

Conclusions
With a long follow-up, patients who develop LRR as first event have a 56% 10-year overall survival. The interval between diagnosis and breast failure, multiple LRR, type of recurrence and surgical treatment were significantly prognostic factors for the overall survival.