乳腺癌保乳术后大分割放疗的进展

Current Progresses in Hypofractionated Radiotherapy after Breast-Conserving Surgery for Breast Cancer

早期乳腺癌保乳术联合辅助放疗可以达到与改良根治术相同的疗效,但是保乳术后辅助放疗的剂量和分割方式多种多样,一般认为辅助放疗的标准剂量和分割方式是50Gy/25F。近年来,越来越多的研究表明,保乳术后大分割放疗(如42.5Gy/16F或者40Gy/15F)可达到与常规分割方式相同的效果,且不会明显增加不良反应。此外,大分割放疗可以缩短疗程,降低治疗费用并节约医疗资源。然而,并不是所有早期乳腺癌患者保乳术后都适合接受大分割放疗。本文将阐述乳腺癌保乳术后大分割放疗的适应证、如何瘤床补量等问题,并总结大分割放疗有望成为乳腺癌保乳术后辅助放疗的新标准放疗方式。

Breast-conserving surgery(BCS)followed by adjuvant radiotherapy is equivalent to modified radical mastectomy.But the dose and fraction schedules of radiotherapy are variable.A total dose of 50 Gy in 25 fractions based on historical assumption is considered as the standard regimen.Hypofractionated radiotherapy including 40 Gy in 15 fractions and 42.5 Gy in 16 fractions after BCS have been proven to achieve equally effective,cosmetic outcome without increased side effects for both early invasive and in situ diseases compared to 50 Gy in 25 fractions in clinical trials.Shorter hypofractionated radio therapy is more convenient,economic for patients,and fewer medical resources are required.But not all early breast cancer patients are suitable for hypofractionated radiotherapy after BCS.This review describes the indications of hypofractionated radiotherapy for breast cancer patients after BCS.It is recommend that hypofractionated radiotherapy could be a new and preferred standard for early breast cancer after BCS.