早期乳腺癌保乳术后的放疗时机

The timing of radiotherapy for early-stage breast cancer after breast-conserving surgery

早期乳腺癌保留乳房手术加放疗的疗效与根治术相同。对术后放疗时机的问题有一些回顾性和随机性研究,但无明确结论,近期的一些随机研究尚需要长期随访。总的来说,对于无需术后化疗的病人应尽早放疗,建议手术放疗间隔最好不超过8周。术后放疗、化疗顺序对疗效无显著影响,先放疗或先化疗均可以。对于腋窝淋巴结转移数较多的远地转移高危病人,术后可先做辅助化疗,但放疗不应延迟到术后7个月以后。如果手术切缘阳性,放疗应尽早开始。同步放化疗可以在不延迟放化疗的基础上提高局部疗效,但疗效提高有限,同时会增加急性和晚期毒副作用,不宜作为常规治疗。特殊病人需要使用时,应选择有效低毒的化疗方案,以降低治疗带来的急性毒副作用和晚期并发症。缩短放疗总时间对需要化疗的病人可以缩短手术到化疗的时间间隔,目前可行的方式有大分割放疗和乳腺瘤床同步补量技术。缩短放疗总时间是否能对疗效改善有影响,有待于临床资料证实。

Breast-conserving surgery plus postoperative breast radiotherapy is considered the standard treatment for early-stage breast cancer. There are a few data on the timing and sequencing of adjuvant radiotherapy and chemotherapy after breast conserving surgery, including retrospective and randomized clinical studies. However, the optimal timing of radiotherapy has not yet been identified. Radiotherapy should be initiated early after surgery for patients who do not need chemotherapy. The surgery-radiotherapy interval is better not beyond 8 weeks. The outcome of patients with breast cancer was not associated with the sequencing of adjuvant radiotherapy and chemotherapy after breast conserving surgery. For patients with more positive nodes and others who have a high risk of distant metastases, chemotherapy could be performed between surgery and radiotherapy, but the surgery-radiotherapy interval is better not beyond 4 to 7 months. For patients with positive margins, radiotherapy should start as early as possible. Concurrent chemoradiotherapy is not considered standard due to treatment -related acute and late toxicities. Hypofractionated radiotherapy or simultaneously tumor bed boost technique can be used to shorten the overall radiation time, but there are scarce clinical data to confirm that shortened overall radiation time has a positive influence on treatment outcome.