Yale University School of Medicine, Department of Therapeutic Radiology, New Haven, CT, USA.
Lancet Oncol. 2015 Mar;16(3):e113-22. doi: 10.1016/S1470-2045(14)71104-0.
This Review assesses the relevant data and controversies regarding the use of radiotherapy for, and locoregional management of, women with triple-negative breast cancer (TNBC). In view of the strong association between BRCA1 and TNBC, knowledge of baseline mutation status can be useful to guide locoregional treatment decisions. TNBC is not a contraindication for breast conservation therapy because data suggest increased locoregional recurrence risks (relative to luminal subtypes) with breast conservation therapy or mastectomy. Although a boost to the tumour bed should routinely be considered after whole breast radiation therapy, TNBC should not be the sole indication for post-mastectomy radiation, and accelerated delivery methods for TNBC should be offered on clinical trials. Preliminary data implying a relative radioresistance for TNBC do not imply radiation omission because radiation provides an absolute locoregional risk reduction. At present, the integration of subtypes in locoregional management decisions is still in its infancy. Until level 1 data supporting treatment decisions based on subtypes are available, standard locoregional management principles should be adhered to.
这篇综述评估了放疗在三阴性乳腺癌（TNBC）中的应用以及局部区域管理的相关数据和争议。鉴于 BRCA1 与 TNBC 之间存在很强的关联，了解基线突变状态对于指导局部区域治疗决策可能是有用的。TNBC 并不是保乳治疗的禁忌症，因为数据表明保乳治疗或乳房切除术的局部区域复发风险（相对于管腔亚型）增加。尽管在全乳放疗后通常应考虑对肿瘤床进行加量放疗，但 TNBC 不应该是乳房切除术后放疗的唯一指征，应在临床试验中提供针对 TNBC 的加速治疗方法。初步数据表明 TNBC 存在相对放射抵抗性，但这并不意味着可以省略放疗，因为放疗可以降低绝对的局部区域风险。目前，在局部区域管理决策中整合亚型的工作仍处于起步阶段。在获得基于亚型的治疗决策的 1 级数据之前，应遵循标准的局部区域管理原则。
