乳腺癌的术中放疗

The role of intraoperatve radiotherapy in the management of breast cancer

乳腺癌是全球女性最高发的恶性肿瘤,不仅威胁患者生命,同时也影响患者的生存质量和生理功能。因此,采用优化的综合治疗策略,延长患者生命,改善患者生存质量,是目前乳腺癌治疗的趋势。放射治疗是乳腺癌综合治疗的重要组成部分,近年来,乳腺癌放射治疗具有照射范围缩小,分割次数减少两大趋势。术中放疗(intraoperative radiotherapy,IORT)由于在手术中直视下给予单次大剂量照射,具有缩短疗程,有效保护正常组织的优势。目前IORT对接受保乳术的乳腺癌患者可作为外照射的局部剂量追加技术方法,或作为替代术后外照射的技术方法。现就IORT技术的优缺点及其临床适应证、疗效和不良反应进行系统回顾,为指导临床开展IORT提供依据。

Breast cancer is the most common disease in women worldwide, which not only threatened the women＇s survival time, but also influenced their quality of life as well. Within this challenge, it＇s important to optimize the current multidisciplinary treatment stratagem for breast cancer. Radiotherapy is one of the most important treatment modality for patients with breast cancer, with the trend to shrink the irradiated volume and shorten the total fraction times in recent years. Intraoperative radiation therapy （IORT） as a fast and convenient procedure has the ability to deliver a high, single-fraction radiation dose to tumor beds with minimal exposure of surrounding tissues （lung, heart, etc.）, which could be displaced or shielded right after the tumor removal during the surgical procedure. Right now, IORT has been either integrated as a boost technique in multimodal approaches using postoperative EBRT in the treatment of early breast cancer patients undergoing breast conservation surgery or used as a single dose accelerated partial breast irradiation technique for these patients. This review discussed the rationale of IORT, the benefits and limitations of IORT, the indication and the clinical results of this procedure, including treatment related side-effects as well in order to provide the preliminary evidence based approach for early breast cancer patients.