Hennequin C, Azria D
Service de cancérologie-radiothérapie, hôpital Saint-Louis, avenue Claude-Vellefaux, 75475 Paris, France.
Cancer Radiother. 2011 Oct;15(6-7):455-9. doi: 10.1016/j.canrad.2011.05.008. Epub 2011 Aug 5.
Various subgroups of breast tumours have been identified during the last 10 years according to the risk of local relapse. Prognostic factors for local relapse are age, surgical margins, tumour size, Her2 expression and hormonal receptors status. For tumours with a high risk of local relapse, an increased in boost dose or the addition of new drugs (trastuzumab, antiangiogenics, PARP inhibitors) could be considered. For low risk tumours, hypofractionated, accelerated partial breast and intraoperative radiotherapy are being evaluated. The classical schedule (45-50 Gy to the whole gland followed by a boost dose of 16 Gy) is no longer the universal rule. Treatment individualization, according to clinical and biological characteristics of the tumour and - possibly - to the radiobiological profile of the patient, is likely to be the future of breast cancer radiotherapy.
在过去十年中，根据局部复发风险已确定了多种乳腺肿瘤亚组。局部复发的预后因素包括年龄、手术切缘、肿瘤大小、Her2表达和激素受体状态。对于局部复发风险高的肿瘤，可考虑增加推量剂量或添加新药（曲妥珠单抗、抗血管生成药物、PARP抑制剂）。对于低风险肿瘤，正在评估大分割、加速部分乳腺放疗和术中放疗。经典方案（全乳照射45-50Gy，随后推量16Gy）不再是通用规则。根据肿瘤的临床和生物学特征以及——可能——患者的放射生物学特征进行个体化治疗，可能是乳腺癌放疗的未来发展方向。
