Sautter-Bihl Marie-Luise, Budach Wilfried, Dunst Jürgen, Feyer Petra, Haase Wulf, Harms Wolfgang, Sedlmayer Felix, Souchon Rainer, Wenz Frederik, Sauer Rolf
Municipal Hospital Karlsruhe, Germany.
Strahlenther Onkol. 2007 Dec;183(12):661-6. doi: 10.1007/s00066-007-1811-1.
The present paper is an update of the practical guidelines for radiotherapy of breast cancer published in 2006 by the breast cancer expert panel of the German Society of Radiation Oncology (DEGRO) [34]. These recommendations have been elaborated on the basis of the S3 guidelines of the German Cancer Society that were revised in March 2007 by an interdisciplinary panel [18].
The DEGRO expert panel performed a comprehensive survey of the literature, comprising lately published meta-analyses, data from recent randomized trials and guidelines of international breast cancer societies, referring to the criteria of evidence- based medicine [25]. In addition to the more general statements of the German Cancer Society, this paper emphasizes specific radiotherapeutic aspects. It is focused on radiotherapy after breast-conserving surgery. Technique, targeting, and dose are described in detail.
Postoperative radiotherapy significantly reduces rates of local recurrence. The more pronounced the achieved reduction is, the more substantially it translates into improved survival. Four prevented local recurrences result in one avoided breast cancer death. This effect is independent of age. An additional boost provides a further absolute risk reduction for local recurrence irrespective of age. Women > 50 years have a hazard ratio of 0.59 in favor of the boost. For DCIS, local recurrence was 2.4% per patient year even in a subgroup with favorable prognostic factors leading to premature closure of the respective study due to ethical reasons. For partial-breast irradiation as a sole method of radiotherapy, results are not yet mature enough to allow definite conclusions.
After breast-conserving surgery, whole-breast irradiation remains the gold standard of treatment. The indication for boost irradiation should no longer be restricted to women <or= 50 years. Partial-breast irradiation is still an experimental treatment and therefore discouraged outside controlled clinical trials. Omission of radiotherapy after breast-conserving surgery of DCIS should be restricted to individual exceptions.
本文是德国放射肿瘤学会（DEGRO）乳腺癌专家小组于2006年发表的乳腺癌放射治疗实用指南的更新版[34]。这些建议是在德国癌症协会2007年3月由一个跨学科小组修订的S3指南基础上制定的[18]。
DEGRO专家小组根据循证医学标准[25]，对文献进行了全面调查，包括最近发表的荟萃分析、近期随机试验的数据以及国际乳腺癌协会的指南。除了德国癌症协会更一般性的声明外，本文还强调了具体的放射治疗方面。重点是保乳手术后的放射治疗。详细描述了技术、靶区和剂量。
术后放疗显著降低局部复发率。降低幅度越大，对生存率提高的影响就越大。每预防4例局部复发可避免1例乳腺癌死亡。这种效果与年龄无关。无论年龄大小，额外的瘤床加量放疗可进一步绝对降低局部复发风险。50岁以上女性接受瘤床加量放疗的风险比为0.59。对于导管原位癌（DCIS），即使在具有良好预后因素的亚组中，局部复发率仍为每年2.4%，由于伦理原因导致相应研究提前结束。对于作为唯一放疗方法的部分乳腺照射，结果尚未成熟到足以得出明确结论。
保乳手术后，全乳照射仍然是治疗的金标准。瘤床加量放疗的适应证不应再局限于年龄≤50岁的女性。部分乳腺照射仍然是一种试验性治疗，因此在对照临床试验之外不建议采用。DCIS保乳手术后不放疗应仅限于个别例外情况。
