Department of Radiotherapy, National Institute of Oncology, Budapest, Hungary.
Radiother Oncol. 2010 Mar;94(3):264-73. doi: 10.1016/j.radonc.2010.01.014. Epub 2010 Feb 22.
To give recommendations on patient selection criteria for the use of accelerated partial-breast irradiation (APBI) based on available clinical evidence complemented by expert opinion.
Overall, 340 articles were identified by a systematic search of the PubMed database using the keywords "partial-breast irradiation" and "APBI". This search was complemented by searches of reference lists of articles and handsearching of relevant conference abstracts and book chapters. Of these, 3 randomized and 19 prospective non-randomized studies with a minimum median follow-up time of 4 years were identified. The authors reviewed the published clinical evidence on APBI, complemented by relevant clinical and pathological studies of standard breast-conserving therapy and, through a series of personal communications, formulated the recommendations presented in this article.
The GEC-ESTRO Breast Cancer Working Group recommends three categories guiding patient selection for APBI: (1) a low-risk group for whom APBI outside the context of a clinical trial is an acceptable treatment option; including patients ageing at least 50 years with unicentric, unifocal, pT1-2 (<or=30 mm) pN0, non-lobular invasive breast cancer without the presence of an extensive intraductal component (EIC) and lympho-vascular invasion (LVI) and with negative surgical margins of at least 2mm, (2) a high-risk group, for whom APBI is considered contraindicated; including patients ageing <or=40 years; having positive margins, and/or multicentric or large (>30 mm) tumours, and/or EIC positive or LVI positive tumours, and/or 4 or more positive lymph nodes or unknown axillary status (pNx), and (3) an intermediate-risk group, for whom APBI is considered acceptable only in the context of prospective clinical trials.
These recommendations will provide a clinical guidance regarding the use of APBI outside the context of a clinical trial before large-scale randomized clinical trial outcome data become available. Furthermore they should promote further clinical research focusing on controversial issues in the treatment of early-stage breast carcinoma.
根据现有临床证据并结合专家意见，就加速部分乳房照射（APBI）的患者选择标准提出建议。
通过系统搜索 PubMed 数据库中使用“部分乳房照射”和“APBI”的关键词，共确定了 340 篇文章。通过对文章参考文献的搜索和对相关会议摘要和书籍章节的手工搜索对其进行补充。其中，确定了 3 项随机对照研究和 19 项前瞻性非随机对照研究，其最低中位随访时间为 4 年。作者复习了 APBI 的已发表临床证据，并结合标准保乳治疗的相关临床和病理研究，通过一系列个人交流，制定了本文提出的建议。
GEC-ESTRO 乳腺癌工作组建议将患者分为三类，指导其选择 APBI：（1）低危组，APBI 是临床试验之外的可接受治疗选择，包括年龄至少 50 岁、单中心、单灶、pT1-2（<或=30mm）pN0、非小叶状浸润性乳腺癌、无广泛导管内成分（EIC）和淋巴管血管侵犯（LVI）、切缘阴性至少 2mm 的患者；（2）高危组，APBI 被认为是禁忌证，包括年龄<或=40 岁、切缘阳性、多中心或大肿瘤（>30mm）、EIC 阳性或 LVI 阳性肿瘤、4 个或更多阳性淋巴结或未知腋窝状态（pNx）的患者；（3）中危组，仅在前瞻性临床试验的背景下，APBI 才被认为是可接受的。
在大规模随机临床试验结果数据可用之前，这些建议将为临床试验背景之外的 APBI 提供临床指导。此外，它们应促进进一步的临床研究，重点关注早期乳腺癌治疗中的争议问题。
