Maingon P, Chapet O, Barillot I, Romestaing P
Département de radiothérapie, centre Georges-François-Leclerc, 1, rue du Professeur-Marion, 21079 Dijon, France.
Cancer Radiother. 2004 Feb;8(1):33-8. doi: 10.1016/j.canrad.2003.09.002.
It is well known that the conservative reference treatment of infiltrative carcinoma of the breast, after en bloc complete excision, should be completed by irradiation of the whole breast delivering 50 Gy in 25 fractions. The discussion related to the validity and the procedures of delivery of the boost of the tumor bed has to be adjusted with our knowledge of specific prognostic factors of local recurrence. Through the two phase III randomized trials published in the literature, the young age of the patient, palpable tumor and negative receptor to progesterone may be recognized as statistically linked to a higher risk of local recurrence. Tumor size and palpable tumor remain unquestionable factors of bad prognosis. The true level of significativeness of age remains controversial as well as peri-tumoral characteristics such as ductal carcinoma in situ. Treatment technique should be rigorous either in terms of prescription of external radiation therapy or for the boost. They have a major impact on the cosmetic result and the fibrosis rate. Improvement of the results is expected through careful analysis of genic and molecularly prognostic factors of the tumor in order to select patients amenable to this type of technique.
众所周知，乳腺浸润性癌整块完整切除后的保守性参考治疗，应通过全乳照射来完成，剂量为50 Gy，分25次给予。关于瘤床加量的有效性和实施程序的讨论，必须根据我们对局部复发的特定预后因素的了解进行调整。通过文献中发表的两项III期随机试验，可以认识到患者年龄小、肿瘤可触及以及孕激素受体阴性在统计学上与局部复发风险较高相关。肿瘤大小和可触及肿瘤仍然是预后不良的无可争议的因素。年龄的真正显著性水平以及诸如原位导管癌等肿瘤周围特征仍然存在争议。无论是在外部放射治疗的处方方面还是在加量方面，治疗技术都应该严格。它们对美容效果和纤维化率有重大影响。通过仔细分析肿瘤的基因和分子预后因素来选择适合这种技术的患者，有望改善治疗结果。
