Chung Christine S, Harris Jay R
Department of Radiation Oncology, Dana-Farber Cancer Institute, Boston, MA 02115, USA.
Breast. 2007 Dec;16 Suppl 2:S78-83. doi: 10.1016/j.breast.2007.07.018. Epub 2007 Aug 21.
Several randomized trials and the most recent meta-analysis from the Oxford Overview have confirmed the efficacy of post-mastectomy radiation therapy (PMRT) in improving local control and long-term survival. The survival advantage of PMRT has been established in patients with a 10% risk of local regional recurrence. Patients with four or more positive lymph nodes fall in this category, even with effective systemic therapy. However, it remains difficult to identify the subset of patients with 1-3 positive lymph nodes at highest risk of local recurrence, who would most likely demonstrate a survival benefit with PMRT. When PMRT is used, careful treatment planning, particularly with regard to cardiac dose, is critical to minimizing serious late effects of treatment. Further developments in pathologic stratification of these patients, guided by expression profiles or novel biologic markers, are required to enable individualized assessment of long-term therapeutic risks and benefits.
多项随机试验以及牛津综述的最新荟萃分析证实了乳房切除术后放射治疗（PMRT）在改善局部控制和长期生存方面的疗效。PMRT的生存优势已在局部区域复发风险为10%的患者中得到确立。有四个或更多阳性淋巴结的患者属于这一类别，即使接受了有效的全身治疗也是如此。然而，仍然难以确定局部复发风险最高的1-3个阳性淋巴结患者亚组，这些患者最有可能从PMRT中获得生存益处。当使用PMRT时，仔细的治疗计划，特别是关于心脏剂量的计划，对于将治疗的严重晚期效应降至最低至关重要。需要在表达谱或新型生物标志物的指导下，对这些患者进行病理分层的进一步发展，以便能够对长期治疗风险和益处进行个体化评估。
