Institute of Cancer Research & Royal Marsden Hospital, Sutton, UK.
Acta Oncol. 2010 Nov;49(8):1288-92. doi: 10.3109/0284186X.2010.509334.
Published results of randomised trials involving >7000 women confirm the safety and efficacy of hypofractionated schedules of adjuvant radiotherapy for women with early breast cancer using fraction sizes between 2 and 3 Gy assuming appropriate downward adjustments to total dose. Unnecessary concerns relating to heart tolerance, suboptimal dose distribution and duration of follow up need not discourage the routine adoption of 15- or 16-fraction schedules in women treated by breast conservation surgery for early breast cancer. Regardless of fractionation regimen, dose escalation to the index quadrant in high risk subgroups will result in a greater relative increase in late adverse effects than tumour control, a therapeutic disadvantage that can only be overcome by exploiting a marked dose-volume effect. A 15-fraction schedule of whole breast radiotherapy is unlikely to represent the lower limits of hypofractionation, and the preliminary results of a 5-fraction regimen are encouraging.
已发表的涉及 >7000 名女性的随机试验结果证实，对于接受保乳手术治疗的早期乳腺癌女性，采用 2-3Gy 分次剂量的适形放疗，在总剂量适当下调的情况下，该方案具有良好的安全性和有效性。对于心脏耐受、剂量分布不理想和随访时间等不必要的担忧，不应妨碍常规采用 15 或 16 分次的治疗方案。无论采用何种分割方案，对于高危亚组，将指数象限的剂量提高都会导致晚期不良反应的相对增加大于肿瘤控制，这是一种治疗劣势，只能通过利用明显的剂量-体积效应来克服。15 分次的全乳放疗方案不太可能代表适形放疗的下限，5 分次方案的初步结果令人鼓舞。
