Bese Nuran Senel, Kiel Krystyna, El-Gueddari Brahim El-Khalil, Campbell Oladapo Babatunde, Awuah Baffour, Vikram Bhadrasain
Cerrahpasa Medical School, Istanbul, Turkey.
Breast J. 2006 Jan-Feb;12 Suppl 1:S96-102. doi: 10.1111/j.1075-122X.2006.00209.x.
Radiotherapy is an essential part of the multimodality treatment of breast cancer. Applying safe and effective treatment requires appropriate facilities, staff, and equipment, as well as support systems, initiation of treatment without undue delay, geographic accessibility, and completion of radiotherapy without undue prolongation of the overall treatment time. Radiotherapy can be delivered with a cobalt-60 unit or a linear accelerator (linac). In early stage breast cancer, radiotherapy is an integral part of breast-conserving treatment. Standard treatment includes irradiation of the entire breast for several weeks, followed by a boost to the tumor bed in women age 50 years or younger or those with close surgical margins. Mastectomy is an appropriate treatment for many patients. Postmastectomy irradiation with proper techniques substantially decreases local recurrences and improves survival in patients with positive axillary lymph nodes. It is also considered for patients with negative nodes if they have multiple adverse features such as a primary tumor larger than 2 cm, unsatisfactory surgical margins, and lymphovascular invasion. Many patients present with locally advanced or inoperable breast cancer. Their initial treatment is by systemic therapy; after responding to systemic therapy, most will require a modified radical mastectomy followed by radiotherapy. For those patients in whom mastectomy is still not possible after initial systemic therapy, breast and regional irradiation is given, followed whenever possible by mastectomy. For patients with distant metastases, irradiation may provide relief of symptoms such as pain, bleeding, ulceration, and lymphedema. A single fraction of irradiation can effectively relieve pain from bone metastases. Radiotherapy is also effective in the palliation of symptoms secondary to metastases in the brain, lungs, and other sites. Radiotherapy is important in the treatment of women with breast cancer of all stages. In developing countries, it is required for almost all women with the disease and should therefore be available.
放射治疗是乳腺癌多模式治疗的重要组成部分。实施安全有效的治疗需要适当的设施、人员和设备，以及支持系统，治疗应及时启动，地理位置应便于患者到达，且放射治疗不应过度延长整个治疗时间。放射治疗可通过钴 - 60 治疗机或直线加速器进行。在早期乳腺癌中，放射治疗是保乳治疗不可或缺的一部分。标准治疗包括对整个乳房进行数周照射，随后对 50 岁及以下或手术切缘接近的女性的瘤床进行追加照射。乳房切除术对许多患者来说是一种合适的治疗方法。采用适当技术进行乳房切除术后放疗可显著降低局部复发率，并提高腋窝淋巴结阳性患者的生存率。对于腋窝淋巴结阴性但具有多个不良特征（如原发肿瘤大于 2 cm、手术切缘不理想和淋巴管浸润）的患者也可考虑进行术后放疗。许多患者表现为局部晚期或不可切除的乳腺癌。他们的初始治疗是全身治疗；在对全身治疗有反应后，大多数患者需要进行改良根治性乳房切除术，随后进行放射治疗。对于那些在初始全身治疗后仍无法进行乳房切除术的患者，先进行乳房和区域照射，尽可能随后进行乳房切除术。对于有远处转移灶的患者，放射治疗可缓解疼痛、出血、溃疡和淋巴水肿等症状。单次照射可有效缓解骨转移引起的疼痛。放射治疗对缓解脑、肺和其他部位转移引起的症状也有效。放射治疗在各期乳腺癌女性的治疗中都很重要。在发展中国家，几乎所有乳腺癌女性都需要放射治疗，因此应提供这种治疗。
