Belkacemi Yazid, Bourgier Céline, Kramar Andrew, Auzac Guillaume, Dumas Isabelle, Lacornerie Thomas, Mége Jean-Pierre, Mijonnet Sylvie, Lemonnier Jerôme, Lartigau Eric
AP-HP, GHU Henri Mondor, Service d'Oncologie-Radiothérapie et Université Paris-Est Créteil (UPEC), Créteil, France.
Clin Adv Hematol Oncol. 2013 Feb;11(2):76-83.
The standard treatment for breast cancer patients at low risk of recurrence is based on conservative surgery followed by radiation therapy delivered to the whole breast. The accelerated partial breast irradiation (APBI) concept, developed more than 15 years ago, could be an option in selected patients. However, the ideal patient profile for APBI is still not clearly identified. Recent reports from the American Society for Radiation Oncology (ASTRO) and the Groupe Européen de Curiethérapie-European Society for Therapeutic Radiology and Oncology (GEC-ESTRO) have suggested selection criteria for "suitable patients" who could receive APBI outside of clinical trials. Currently, there are 6 ongoing phase III trials. All are characterized by a significant heterogeneity regarding inclusion criteria and stratification factors. The French UNICANCER trial (SHARE; ClinicalTrials.gov identifier NCT01247233) will randomize 2,800 patients in 3 arms: APBI (1 week) using 3-dimensional (3D) conformal radiotherapy, standard radiotherapy (6.5 weeks), and hypofractionated radiotherapy (3 weeks). In this article, we review the reported retrospective studies as well as older randomized trials. We will also describe the differences between the 6 ongoing phase III trials and the particularities of the French SHARE trial.
对于复发风险较低的乳腺癌患者,标准治疗方案是先进行保守手术,然后对整个乳房进行放射治疗。15年多前提出的加速部分乳腺照射(APBI)概念,可能适用于部分特定患者。然而,APBI的理想患者特征仍未明确界定。美国放射肿瘤学会(ASTRO)和欧洲近距离治疗协作组-欧洲治疗放射学与肿瘤学学会(GEC-ESTRO)近期发布的报告提出了“合适患者”的选择标准,这些患者可在临床试验之外接受APBI治疗。目前有6项正在进行的III期试验。所有试验在纳入标准和分层因素方面均存在显著异质性。法国UNICANCER试验(SHARE;ClinicalTrials.gov标识符NCT01247233)将把2800名患者随机分为3组:采用三维(3D)适形放疗的APBI(1周)、标准放疗(6.5周)和大分割放疗(3周)。在本文中,我们回顾了已发表的回顾性研究以及较早的随机试验。我们还将描述6项正在进行的III期试验之间的差异以及法国SHARE试验的特点。