早期乳腺癌患者保乳术后免除放疗的研究进展

Research progress of exemption from radiotherapy after breast-conserving surgery in patients with early-stage breast cancer

乳腺癌患者保乳手术后行放疗是早期乳腺癌的标准治疗模式。由于影像学、手术、分子病理学的进步,乳腺癌患者中低风险人群可以进行放射治疗的降级,甚至合理地免除放疗来减少不良反应。本文综述了乳腺癌放疗降级的一个演变过程,回顾相关病理检测及基因检测在乳腺癌放疗中对其预后的评估作用,并讨论激素受体阳性乳腺癌患者结合多种分子检测进行免除放疗的相关试验,利用现有的肿瘤生物学和分子检测精准确定保乳术后可以安全免除放疗的患者群体。

Radiotherapy after breast-conserving surgery for patients with breast cancer is the standard treatment modality for early-stage breast cancer.Due to advances in imaging,surgery,and molecular pathology,downgrading of radiotherapy or even reasonable exemption from radiotherapy can be performed in low-risk patients with breast cancer to minimize the adverse effects of radiotherapy.This article reviews the evolutionary process of radiotherapy downgrading in breast cancer and the role of relevant pathological tests and genetic tests in assessing the prognosis of patients with breast cancer in radiotherapy,and discusses relevant trials on patients with hormone receptor-positive breast cancer combining multiple molecular tests for exemption from radiotherapy to identify patient groups that can be safely exempted from radiotherapy after breast-conserving surgery using available tumor biology and molecular predictions.