Sautter-Bihl Marie-Luise, Sedlmayer Felix
Klinik für Radioonkologie und Strahlentherapie, Städtisches Klinikum Karlsruhe, Germany.
Department of Radiotherapy and Radiation Oncology, LKH Salzburg, Paracelsus Medical University Hospital, Salzburg, Austria.
Breast Care (Basel). 2015 Aug;10(4):254-8. doi: 10.1159/000438662. Epub 2015 Aug 19.
International guidelines reveal substantial differences regarding indications for regional nodal irradiation (RNI). Recently, several randomized studies provided new insights and these are discussed here. Patients with 1-3 positive nodes seem to profit from RNI compared to whole-breast (WBI) or chest-wall irradiation (CWI) alone, both with regard to locoregional control and disease-free survival. Irradiation of the regional lymphatics including axillary, supraclavicular and internal mammary nodes provided a small but significant survival benefit in recent randomized trials and 1 meta-analysis. Lymph node irradiation yields comparable tumor control in comparison to axillary lymph node dissection while reducing the rate of lymph edema. Data concerning the impact of 1-2 macroscopically affected sentinel nodes or microscopic metastases on prognosis are equivocal. Recent data suggest that the current restrictive use of RNI should be scrutinized, as the hazard-benefit relation appears to shift towards an improvement of outcome.
国际指南显示,区域淋巴结照射(RNI)的适应症存在显著差异。最近,几项随机研究提供了新的见解,在此进行讨论。与单纯全乳照射(WBI)或胸壁照射(CWI)相比,有1 - 3个阳性淋巴结的患者似乎从RNI中获益,无论是在局部区域控制还是无病生存方面。在最近的随机试验和1项荟萃分析中,包括腋窝、锁骨上和内乳淋巴结在内的区域淋巴管照射带来了虽小但显著的生存益处。与腋窝淋巴结清扫相比,淋巴结照射在控制肿瘤方面效果相当,同时降低了淋巴水肿的发生率。关于1 - 2个肉眼可见受累前哨淋巴结或微小转移对预后影响的数据并不明确。近期数据表明,当前对RNI的限制性使用应受到审视,因为风险 - 获益关系似乎朝着改善预后的方向转变。