符合ACOSOG Z0011研究标准乳腺癌的放疗问题

Radiotherapeutic strategies for breast cancer patients in accordance with ACOSOG Z0011 study criteria

腋窝淋巴结清扫作为前哨淋巴结阳性乳腺癌病人的标准治疗模式,在降低区域复发的同时增加了诸如淋巴水肿、关节活动受限等并发症。作为一项具有改变临床实践意义的研究,Ⅲ期随机对照研究美国外科医师协会肿瘤学组(ACOSOG)Z0011探讨在临床N0期病人中安全减免前哨淋巴结活检阳性后的腋窝淋巴结清扫,为这部分病人的腋窝处理提供了新选择,但也给辅助放疗决策带来了新问题。作为ACOSOG Z0011及其同时代的AMAROS和IBCSG 23-01两项研究,虽然在入组标准样本量和统计学效能,乃至放射治疗的质控均存在一定的局限性,但是均证实在不同的前提下,低负荷前哨淋巴结转移的病人确实可以有条件地减免腋窝淋巴结清扫,代表了现代综合治疗时代下乳腺外科再一次探索降低腋窝手术带来损伤的努力,也代表了放射治疗作为和手术治疗互补的局部区域治疗重要手段在新的科学时代需要重新审视和定位。

Axillary lymph node dissection （ALND）is the standard treatment for patients with sentinel-positive breast cancer, which would increase the risk of adverse outcomes including lymphedema and limited shoulder/arm motion while reducing regional recurrence. Phase Ⅲ ACOSOG ZOOll trial, as a practice-changing study, explored the safety of obviation of ALND among clinical nodal negative patients with 1-2 positive sentinel lymph nodes, providing a new option for axillary management in the group of patients, and bringing new challenges to adjuvant radiotherapy decisions. Although ACOSOG Z0011 and its contemporaries, AMAROS and IBCSG 23-01 studies, have limitations in standard sample size and statistical efficacy, and even in radiotherapy charges, they have confirmed that patients with low load sentinel lymph node metastases can indeed be conditionally relieved axillary lymph node dissection under different conditions. These studies represents the efforts of breast surgery to reduce axillary surgery injury in the era of modern comprehensive treatment, and also represents the need to re-examine and re-orientate radiotherapy as an important means of local treatment complementary to surgical treatment in the new scientific era.