Department of Surgery, The University of Melbourne, Parkville 3050, Australia; The Breast Service, The Royal Melbourne and Royal Women's Hospital, Parkville 3052, Australia.
Surgeon. 2013 Oct;11(5):278-85. doi: 10.1016/j.surge.2013.03.005. Epub 2013 Apr 28.
Radiotherapy following breast conservation is routine in the treatment of invasive breast cancer and is commonly used in ductal carcinoma in situ to decrease local recurrence. However, adjuvant breast radiotherapy has significant short and longer-term side effects and consumes substantial health care resources. We aimed to review the randomised controlled trials and attempted to identify clinico-pathological factors and molecular markers associated with the risk of local recurrence.
A literature search using the Medline and Ovid databases between 1965 and 2011 was conducted using the terms 'breast conservation' and radiotherapy, and radiotherapy and DCIS. Only papers with randomised clinical trials published in English in adult were included. Only Level 2 evidence and above was included.
Three meta-analyses and 17 randomised controlled trials have been published in invasive disease and one meta-analysis and four randomised controlled trials for DCIS. Overall, adjuvant radiotherapy provides a 15.7% decrease in local recurrence and 3.8% decrease in 15-year risk of breast cancer death. The key clinico-pathological factors, which enable stratification into high, intermediate or low risk groups include age, oestrogen receptor positivity, use of tamoxifen and extent of surgery. Absolute reductions in 15-year risk of breast cancer death in these three prediction categories are 7.8%, 1.1%, and 0.1% respectively Adjuvant radiotherapy provides a 60% risk reduction in local recurrence in DCIS with no impact on distal metastases or overall survival. Size, pathological subtype and margins are major risk factors for local recurrence in DCIS.
Adjuvant radiotherapy consistently decreases local recurrence across all subtypes of invasive and in-situ disease. While it has a survival advantage in those with invasive disease, this is not seen with DCIS and is minimal in invasive disease where the risk of local recurrence is low. This group includes women over 70 with node negative, ER positive tumours<2 cm.
保乳术后放疗是治疗浸润性乳腺癌的常规方法，常用于导管原位癌以降低局部复发率。然而，辅助乳腺癌放疗有显著的短期和长期副作用，并消耗大量的医疗保健资源。我们旨在回顾随机对照试验，并试图确定与局部复发风险相关的临床病理因素和分子标志物。
使用 Medline 和 Ovid 数据库进行文献检索，检索词为“breast conservation”和“radiotherapy”，以及“radiotherapy”和“DCIS”。只纳入以英语发表的、成人的随机临床试验的论文。仅纳入 2 级及以上证据。
共发表了 3 项荟萃分析和 17 项浸润性疾病的随机对照试验，1 项荟萃分析和 4 项 DCIS 的随机对照试验。总的来说，辅助放疗可使局部复发率降低 15.7%，15 年乳腺癌死亡风险降低 3.8%。能够分层为高、中、低风险组的关键临床病理因素包括年龄、雌激素受体阳性、使用他莫昔芬和手术范围。在这三个预测类别中，15 年乳腺癌死亡风险的绝对降低分别为 7.8%、1.1%和 0.1%。辅助放疗可使 DCIS 的局部复发风险降低 60%，但对远处转移或总生存无影响。大小、病理亚型和切缘是 DCIS 局部复发的主要危险因素。
辅助放疗可降低所有浸润性和原位疾病亚型的局部复发率。虽然在浸润性疾病中具有生存优势，但在 DCIS 中未见此优势，且在局部复发风险较低的浸润性疾病中优势最小。这组包括淋巴结阴性、ER 阳性、<2cm 的 70 岁以上女性。
Zotero 插件