乳腺导管内癌保留乳房术后全乳腺大分割放疗研究进展

Advance on whole breast hypofractionated radiotherapy in patients with ductal carcinoma in situ following breast-conserving surgery

目的大分割放疗在早期浸润乳腺癌保留乳房手术(breast conserving surgery,BCS)后放疗已逐渐得到认可。本研究对大分割放疗方案在乳腺导管内癌(ductal carcinoma in situ,DCIS)BCS后的研究现状进行综述。方法应用PubMed、中国知网和中国生物医学文献数据库检索系统,以"乳腺导管内癌或导管原位癌(carcinoma,ductal,breast;carcinoma,intraductal,noninfiltrating;ductal carcinoma in situ)、保留乳房术(breast-conserving surgery;mastectomy,segmental)、放射治疗(radiotherapy)、剂量分割(dose fractionation)、大分割或低分割(hypofractionation)"为主题词或关键词,检索1979-01-01-2016-3-11发表的文章,共检索到中文文献0篇,英文40篇。纳入标准:乳腺导管内癌保留乳房术后全乳腺大分割放疗的临床研究,根据纳入标准,纳入12篇。剔除标准:(1)部分乳腺放疗;(2)单纯剂量学研究。根据剔除标准,剔除3篇。最终纳入分析文献19篇。结果乳腺导管内癌保留乳房术后全乳腺大分割放疗局部控制、晚期放疗副反应与常规放疗相当,但最佳剂量分割方式仍不是很清楚。结论对DCIS BCS后患者而言,大分割放疗治疗周期短,且花费低,可望成为DCIS BCS后的标准治疗方案,但仍需要进一步研究。

OBJECTIVE Whole-breast hypofractionated radiotherapy has been increasingly accepted after breastconserving surgery for invasive breast cancer,what is the advance of this strategy on carcinoma in situ ductal（DCIS）following breast-conserving surgery will be reviewed in this article.METHODS Forty english and 0Chinese literatures were detected by PUBMED,CHKD or CBM search（1January 1979 to 11March 2016）using the terms＂carcinoma,ductal,breast,carcinoma,intraductal,noninfiltrating,ductal carcinoma in situ,breast-conserving surgery,mastectomy,segmental,radiotherapy,dose fractionation,Hypofractionation＂as Subject Words or Free Words.Selection Criteria：the clinical study on DCIS treated with whole breast hypofractionated radiotherapy after breast conserving surgery.Totally 12 english literatures were selected.Rejection criteria：partial breast radiotherapy,dosimetry study.Three English literature were rejected.Finally 19 english literature were analyzed.RESULTS It is equivalent for local control and late toxic effects between whole breast hypofractionated radiotherapy and conventional fractionated radiotherapy for DCIS after breast-conserving surgery,but the optimal strategy of dose fractionation is still unclear.CONCLUSION For patients with DCIS after breast conserving surgery,hypofractionated radiotherapy have shorter treating period and lower costs,the strategy may become the standard therapy companied with further study.