Karasawa Kumiko, Hirowatari Hisako, Izawa Hiromi, Furuya Tomohisa, Takada Takahiro, Ito Kana, Saito Anneyuko, Kurokawa Chie, Ozawa Shuichi
Division of Radiation Oncology, Department of Radiology, Juntendo University, School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan.
Gan To Kagaku Ryoho. 2007 Jun;34(6):853-7.
Radiotherapy has been widely used in breast cancer in many situations. These are breast irradiation of breast conserving therapy,post mastectomy regional irradiation,irradiation for regional lymph nodes recurrence,breast irradiation of inoperable locally advanced cases,palliative irradiation of brain metastasis,bone metastasis and so on. The relationship among radiotherapy,surgery and systemic therapy has to be considered in those situations. In breast conserving therapy, the usefulness of breast irradiation is well established. Otherwise, a local controllability depend on a grade of residual tumor cell has not been understand. The authors conducted the survey of 941 cases of positive surgical margins and found that doses more than 60 Gy has a tendency for better local control in post menopausal cases. To reduce patient's burden,3 weeks short course irradiation (Canadian protocol) or accelerated partial breast irradiation have been introduced in breast irradiation. A subgroup which has no need to irradiate to conserving breast had not been identified. The timing between postoperative chemotherapy and irradiation is another point that has to be considered. To reduce distant metastasis,chemotherapy first has been considered better. As for post mastectomy regional irradiation, improvement of local and systemic control has been widely known these days. A timing of systemic therapy and irradiation is a point has to consider. In inoperable or far advanced T 4 tumors, breast irradiation with concurrent chemotherapy must be considered in stead of surgery. We have to know a big shortage in Japanese cancer treatment situation that we have few radiation oncologists or medical physicists in Japan. We have to educate those specialists to catch up with increasing cancer patients.
放射治疗在多种情况下已广泛应用于乳腺癌。这些情况包括保乳治疗中的乳腺照射、乳房切除术后区域照射、区域淋巴结复发的照射、局部晚期不可手术病例的乳腺照射、脑转移和骨转移的姑息性照射等。在这些情况下，必须考虑放射治疗、手术和全身治疗之间的关系。在保乳治疗中，乳腺照射的有效性已得到充分证实。否则，局部可控性取决于残留肿瘤细胞的分级这一点尚未被理解。作者对941例手术切缘阳性病例进行了调查，发现绝经后病例中剂量超过60 Gy有更好的局部控制趋势。为减轻患者负担，在乳腺照射中引入了3周短程照射（加拿大方案）或加速部分乳腺照射。尚未确定无需对保乳进行照射的亚组。术后化疗与照射之间的时机是另一个必须考虑的问题。为减少远处转移，先进行化疗被认为更好。至于乳房切除术后区域照射，局部和全身控制的改善如今已广为人知。全身治疗与照射的时机是一个必须考虑的问题。对于不可手术或晚期T4肿瘤，必须考虑用同步化疗进行乳腺照射而非手术。我们必须认识到日本癌症治疗状况的一个重大不足，即日本放疗肿瘤学家或医学物理师很少。我们必须培养这些专家以应对不断增加的癌症患者。
