Research Unit of Medical Senology, European Institute of Oncology, Via Ripamonti 435, 20141 Milan, Italy.
Cancer Treat Rev. 2010 Oct;36(6):443-50. doi: 10.1016/j.ctrv.2010.02.019. Epub 2010 Mar 20.
In the last two decades, systemic adjuvant treatment for breast cancer, in association with radiotherapy, has been shown to prolong disease-free survival and overall survival in patients with operable breast tumors. So far, the optimal sequence of systemic therapy and radiotherapy for breast cancer patients after conservative surgery or mastectomy is unclear. Several retrospective analyses showed a possible detrimental effect on local regional recurrence rates when radiation therapy is delayed after chemotherapy. On the other hand, delaying chemotherapy after radiotherapy may increase the risk of distant failure and affect the survival. Concurrent administration of targeted treatment (e.g. non-anthracycline/taxane containing chemotherapy, trastuzumab, endocrine therapy) with radiotherapy is considered a valid option. A "tailored" approach on sequencing of chemotherapy and radiotherapy which takes into account various variables, such as histological and biological features of the tumor, as well as the patient status and the treatment modality is required in order to optimize the delivery of adjuvant treatments. This review focuses on the effects of timing of chemotherapy-radiotherapy and risks of relapse, in terms of locoregional and distant recurrence in patients with operable breast cancer.
在过去的二十年中，与放疗联合的全身辅助治疗已被证明可延长可手术乳腺癌患者的无病生存期和总生存期。迄今为止，对于接受保乳手术或乳房切除术的乳腺癌患者，全身治疗与放疗的最佳序贯仍不明确。几项回顾性分析显示，化疗后延迟放疗可能会对局部区域复发率产生不利影响。另一方面，放疗后延迟化疗可能会增加远处失败的风险并影响生存。同步进行靶向治疗（如非蒽环类/紫杉类化疗、曲妥珠单抗、内分泌治疗）与放疗被认为是一种有效的选择。为了优化辅助治疗的实施，需要采用一种“量身定制”的方法来考虑各种变量，如肿瘤的组织学和生物学特征，以及患者的状况和治疗方式，来确定化疗和放疗的序贯。这篇综述重点关注可手术乳腺癌患者的化疗-放疗时间以及局部区域和远处复发的复发风险。
