Cutuli B
Institut du cancer Courlancy radiothérapie-oncologie, Reims, France.
Cancer Radiother. 2012 Sep;16(5-6):493-502. doi: 10.1016/j.canrad.2012.07.185. Epub 2012 Aug 25.
Postoperative radiotherapy remains essential in breast cancer in 2012. After conserving surgery, it reduces local recurrence risks from 50 to 70%, both for ductal carcinoma in situ and invasive cancers. This was confirmed in several randomized trials and three meta-analyses. The boost increases local control in invasive cancers, but its role should be better defined in ductal carcinoma in situ. Among the latter, there is no clearly identified subgroup for which radiotherapy could be avoided. Local recurrence risk factors are now well-identified both for ductal carcinoma in situ and invasive cancers, with an inclusion, for the latter, of new molecular subgroups. After mastectomy, radiotherapy reduces local recurrence rates from 60 to 70%, especially among patients with axillary nodal involvement, with, in parallel, a 7 to 9% increased survival rate. In order to reduce the waiting list and to avoid under treatment, especially in the elderly, several hypofractionated radiotherapy schemes have been developed for several years. Three randomized trials confirmed similar results to classical radiotherapy. For ten years, several techniques of partial breast irradiation have been developed, with various doses and treated volumes. The optimal indications should be defined according to the new international guidelines.
2012年，术后放疗在乳腺癌治疗中仍然至关重要。保乳手术后，对于导管原位癌和浸润性癌，它可将局部复发风险从50%降至70%。这在多项随机试验和三项荟萃分析中得到了证实。加量放疗可提高浸润性癌的局部控制率，但其在导管原位癌中的作用仍有待进一步明确。在导管原位癌中，尚无明确可避免放疗的亚组。导管原位癌和浸润性癌的局部复发危险因素现已明确，对于浸润性癌，还纳入了新的分子亚组。乳房切除术后，放疗可将局部复发率从60%降至70%，尤其是在有腋窝淋巴结受累的患者中，同时生存率提高7%至9%。为了减少等待名单并避免治疗不足，特别是在老年患者中，数年来已开发了几种大分割放疗方案。三项随机试验证实其结果与传统放疗相似。十年来，已开发了几种部分乳腺照射技术，剂量和治疗体积各不相同。应根据新的国际指南确定最佳适应证。
