文章：

保乳术后放疗所致乳房水肿：临床意义分类的引入及常规与低分割治疗后的发生率评估

Breast Edema After Breast-Conserving Surgery and Radiotherapy: Introduction of a Clinically Meaningful Classification and Evaluation of the Incidence After Normo- and Hypofractionated Treatments

原文发布日期：16 July 2025

DOI: 10.3390/cancers17142368

类型: Article

开放获取: 是

英文摘要：

BE following RT after breast-conserving surgery is a common concern, impacting patients’ quality of life. This study introduces a clinically meaningful classification system for BE and retrospectively evaluates its incidence among patients treated with normofractionated (nfRT) and hypofractionated (hfRT) regimens. Data from 1156 patients treated between 2011 and 2021 were analyzed. BE was graded according to the CTC and a so-called “WST classification” (grade 1: lymphatic drainage performed by the patient; grade 2: professional lymphatic drainage; grade 3: surgery). A total of 33%/17% developed BE according to the WST classification/CTC. Grade III BE was not reported. About 70% experienced a remission of BE during follow-up. Risk factors for the development of BE included RT of lymphatic drainage, complete axillary dissection compared to sentinel node dissection, and CTX. CTX was not confirmed in multivariate analysis. The incidence of BE did not differ significantly between the nfRT and hfRT groups, affirming the safety and comparability of hfRT regarding BE risk (HR: 0.833,p= 0.1219). This study emphasizes the importance of precise and standardized BE classification for improved treatment outcomes. Given its comparable risk profile and potential for enhanced therapy adherence, the findings support hfRT as a preferred regimen aligned with the current guidelines.

摘要翻译： 

保乳术后放疗（RT）后的臂淋巴水肿（BE）是临床常见问题，显著影响患者生活质量。本研究提出具有临床意义的BE分级系统，并回顾性分析常规分割（nfRT）与大分割（hfRT）放疗方案患者的BE发生率。研究纳入2011年至2021年间接受治疗的1156例患者数据，采用CTCAE标准及新型"WST分级系统"（1级：患者自我淋巴引流；2级：专业淋巴引流治疗；3级：需手术干预）进行评估。结果显示，按WST分级/CTCAE标准分别有33%/17%患者发生BE，未出现3级BE病例，约70%患者在随访期间BE症状缓解。BE发生风险因素包括淋巴引流区放疗、全腋窝淋巴结清扫（对比前哨淋巴结活检）及化疗（CTX），但多变量分析未证实CTX的独立风险作用。nfRT与hfRT组间BE发生率无显著差异（HR: 0.833, p=0.1219），证实hfRT在BE风险方面具有与nfRT相当的安全性。本研究强调精确标准化BE分级对改善治疗结局的重要性，基于相当的风险特征及潜在治疗依从性优势，研究结果支持hfRT作为符合现行指南的优选放疗方案。

原文链接：

Breast Edema After Breast-Conserving Surgery and Radiotherapy: Introduction of a Clinically Meaningful Classification and Evaluation of the Incidence After Normo- and Hypofractionated Treatments