Hôpital Neuchâtelois, Radiation Oncology Department, Rue de Chasseral 20, 2300, La Chaux-de-Fonds, Switzerland; Centre Hospitalier Universitaire Vaudois (CHUV), Division of Oncology, Radio-Oncology Department, Rue de Bugnon 46, CH-1011, Lausanne, Switzerland; Radio-Oncology Research Laboratory of the CHUV, Biopole III - 9A Rue de la Corniche, 1066, Epalinges, Lausanne, Switzerland.
Centre Hospitalier Universitaire Vaudois (CHUV), Division of Oncology, Radio-Oncology Department, Rue de Bugnon 46, CH-1011, Lausanne, Switzerland; Radio-Oncology Research Laboratory of the CHUV, Biopole III - 9A Rue de la Corniche, 1066, Epalinges, Lausanne, Switzerland.
Crit Rev Oncol Hematol. 2017 Feb;110:43-48. doi: 10.1016/j.critrevonc.2016.12.006. Epub 2016 Dec 8.
Systemic treatments are tailored to breast cancer (BC) heterogeneity, which is not yet taken into account for radiotherapy (RT) personalization. The primary objective of this review is to summarize existing data suggesting BC subtypes and genetic assays are prognostic and predictive biomarkers useful for RT decision-making and to provide implications for their incorporation into future translational and clinical research. The evidence suggesting that BC subtypes also exhibit distinct "locoregional recurrence (LRR)" patterns is retrospective but consistent and validated in over fifteen studies. The HER-2 positive and triple negative subtypes are the most susceptible to locoregional failure. The high risk of the HER-2 positive subtype can be reversed with trastuzumab administration. Very little is known on the subtypes' intrinsic radiosensitivity properties. Genetic assays have assessed retrospectively signatures' prognostic and predictive value in patients' cohorts (several coming from prospective studies) for LRR risk and radiotherapy (RT) benefit. Further confirmation is needed before their introduction into clinical routine. Evidence on the use of molecular biomarkers for adjuvant RT tailoring is emerging but needs validation and introduction into prospective studies. The plethora of modern RT options (partial breast irradiation, hypofractionation), as well as recent evidence pointing towards more extensive radiotherapy, demand introduction of biological features into clinical trials to improve therapeutic decisions. Open questions, such as tailoring of irradiation after neo-adjuvant chemotherapy in complete responders and the understanding of the interplay between local control, systemic recurrence and survival given modern systemic treatments, need to be addressed under the prism of biology within this heterogeneous disease. Intrinsic radiobiological properties within this heterogeneity need to be highlighted in order to further improve outcomes.
系统治疗针对乳腺癌 (BC) 的异质性进行了调整，但放射治疗 (RT) 的个性化治疗尚未考虑到这种异质性。本综述的主要目的是总结现有数据，这些数据表明 BC 亚型和遗传检测可作为用于 RT 决策的预后和预测生物标志物，并为将其纳入未来的转化和临床研究提供依据。表明 BC 亚型还表现出不同的“局部区域复发 (LRR)”模式的证据虽然是回顾性的，但在超过十五项研究中是一致且经过验证的。HER-2 阳性和三阴性亚型最容易发生局部区域失败。曲妥珠单抗的应用可以逆转 HER-2 阳性亚型的高风险。关于亚型内在放射敏感性的特性知之甚少。遗传检测已经回顾性地评估了患者队列中特征的预后和预测价值（其中一些来自前瞻性研究），用于预测 LRR 风险和放疗 (RT) 获益。在将其引入临床常规之前，还需要进一步确认。关于辅助 RT 个体化使用分子生物标志物的证据正在出现，但需要验证并纳入前瞻性研究。现代 RT 选择（部分乳房照射、短程放疗）繁多，以及最近指向更广泛放疗的证据，需要将生物学特征引入临床试验，以改善治疗决策。需要从生物学的角度来解决一些悬而未决的问题，例如新辅助化疗后完全缓解者的照射个体化以及在现代全身治疗下局部控制、全身复发和生存之间相互作用的理解。在这种异质性疾病中，需要突出这种异质性内的固有放射生物学特性，以进一步提高疗效。
