Recht Abram, Comen Elizabeth A, Fine Richard E, Fleming Gini F, Hardenbergh Patricia H, Ho Alice Y, Hudis Clifford A, Hwang E Shelley, Kirshner Jeffrey J, Morrow Monica, Salerno Kilian E, Sledge George W, Solin Lawrence J, Spears Patricia A, Whelan Timothy J, Somerfield Mark R, Edge Stephen B
Beth Israel Deaconess Medical Center, Boston, MA, USA.
Memorial Sloan Kettering Cancer Center, New York, USA.
Ann Surg Oncol. 2017 Jan;24(1):38-51. doi: 10.1245/s10434-016-5558-8. Epub 2016 Sep 19.
A joint American Society of Clinical Oncology, American Society for Radiation Oncology, and Society of Surgical Oncology panel convened to develop a focused update of the American Society of Clinical Oncology guideline concerning use of postmastectomy radiotherapy (PMRT).
A recent systematic literature review by Cancer Care Ontario provided the primary evidentiary basis. The joint panel also reviewed targeted literature searches to identify new, potentially practice-changing data.
The panel unanimously agreed that available evidence shows that PMRT reduces the risks of locoregional failure (LRF), any recurrence, and breast cancer mortality for patients with T1-2 breast cancer with one to three positive axillary nodes. However, some subsets of these patients are likely to have such a low risk of LRF that the absolute benefit of PMRT is outweighed by its potential toxicities. In addition, the acceptable ratio of benefit to toxicity varies among patients and physicians. Thus, the decision to recommend PMRT requires a great deal of clinical judgment. The panel agreed clinicians making such recommendations for individual patients should consider factors that may decrease the risk of LRF, attenuate the benefit of reduced breast cancer-specific mortality, and/or increase risk of complications resulting from PMRT. When clinicians and patients elect to omit axillary dissection after a positive sentinel node biopsy, the panel recommends that these patients receive PMRT only if there is already sufficient information to justify its use without needing to know additional axillary nodes are involved. Patients with axillary nodal involvement after neoadjuvant systemic therapy should receive PMRT. The panel recommends treatment generally be administered to both the internal mammary nodes and the supraclavicular-axillary apical nodes in addition to the chest wall or reconstructed breast.
美国临床肿瘤学会、美国放射肿瘤学会和外科肿瘤学会联合成立了一个小组，以对美国临床肿瘤学会关于乳房切除术后放疗（PMRT）使用的指南进行重点更新。
安大略癌症护理中心最近进行的一项系统文献综述提供了主要证据基础。联合小组还审查了有针对性的文献检索，以识别新的、可能改变实践的数据。
小组一致认为，现有证据表明，PMRT可降低T1-2期乳腺癌且腋窝淋巴结1-3个阳性患者的局部区域复发（LRF）、任何复发以及乳腺癌死亡率风险。然而，这些患者中的一些亚组LRF风险可能很低，以至于PMRT的绝对获益被其潜在毒性所抵消。此外，可接受的获益与毒性比在患者和医生之间各不相同。因此，推荐PMRT的决定需要大量的临床判断。小组一致认为，为个体患者做出此类推荐的临床医生应考虑可能降低LRF风险、减弱降低乳腺癌特异性死亡率的获益和/或增加PMRT所致并发症风险的因素。当临床医生和患者在哨兵淋巴结活检阳性后选择省略腋窝淋巴结清扫时，小组建议，只有在已有足够信息证明其使用合理且无需知道是否有更多腋窝淋巴结受累的情况下，这些患者才应接受PMRT。新辅助全身治疗后有腋窝淋巴结受累的患者应接受PMRT。小组建议，除胸壁或重建乳房外，一般还应对内乳淋巴结和锁骨上-腋窝尖淋巴结进行治疗。
