Polo Alfredo, Polgár Csaba, Hannoun-Levi Jean-Michel, Guinot Jose-Luis, Gutierrez Cristina, Galalae Razvan, van Limbergen Erik, Strnad Vratislav
Radiation Oncology Department, Hospital Universitario Ramon y Cajal, Madrid, Spain.
Center of Radiotherapy, National Institute of Oncology, Budapest, Hungary.
Brachytherapy. 2017 May-Jun;16(3):552-564. doi: 10.1016/j.brachy.2017.03.003. Epub 2017 Apr 1.
The aim of the study was to give recommendations on patient selection criteria for the administration of boost doses after whole-breast irradiation (WBI) in invasive breast cancer based on available clinical evidence complemented by expert opinion.
A systematic search of the PubMed database was conducted to identify factors associated with increased risk for local failure that can define risk groups, and to provide evidence for an adequate guidance to the use of the boost as a function of the risk of local recurrence in breast-conserving therapy. The authors reviewed the published clinical evidence for the use of boost after WBI, complemented by other relevant studies and, through a series of formal meetings communications, formulated the recommendations presented in this article.
The GEC-ESTRO Breast Cancer Working Group recommends three categories guiding patient selection for the use of a boost after WBI: (1) a low-risk group for whom boost adds little benefit, including patients aging at least 50 years with unicentric, unifocal, and clear surgical margins of at least 2 mm and no axillary lymph nodes invasion. In this group, a boost of 10-16 Gy EQD2 after WBI (25fr × 2 Gy or 15 fr × 2.67 Gy) is optional and not mandatory, (2) a high-risk group, for whom boost is considered mandatory and where dose escalation above 16 Gy EQD2 should be considered; including patients aging ≤40 years with close margins, extensive intraductal component or triple-negative phenotype, or patients with positive resection margins regardless of patient age, and (3) an intermediate-risk group, for whom the boost (10-16 Gy EQD2) is considered mandatory, includes patients below 40 years without major risk criteria, patients >40 years and <50 years regardless of any risk factors, or patients >50 years with any risk factor (close margins, tumor size >3 cm, extensive intraductal component, lymphovascular invasion, lymph node invasion, multicentric or multifocal tumors, triple-negative phenotype, or after neoadjuvant chemotherapy in case of residual tumor).
These recommendations may provide a clinical guidance regarding the use of boost after WBI in invasive breast cancer and holds for standard and hypofractionated WBI. Furthermore they should promote further clinical research focusing on controversial issues in the treatment of early-stage breast carcinoma.
本研究旨在基于现有临床证据并辅以专家意见，对浸润性乳腺癌全乳照射（WBI）后给予追加剂量照射的患者选择标准提出建议。
对PubMed数据库进行系统检索，以确定与局部复发风险增加相关的因素，这些因素可用于定义风险组，并为根据保乳治疗中局部复发风险来合理指导追加剂量照射的使用提供证据。作者回顾了WBI后使用追加剂量照射的已发表临床证据，并辅以其他相关研究，通过一系列正式会议交流，制定了本文中的建议。
GEC-ESTRO乳腺癌工作组推荐了三类指导WBI后使用追加剂量照射的患者选择标准：（1）低风险组，追加剂量照射获益不大，包括年龄至少50岁、肿瘤单中心、单灶、手术切缘至少2mm且无腋窝淋巴结侵犯的患者。在该组中，WBI后追加10 - 16Gy等效剂量（EQD2）（25次分割×2Gy或15次分割×2.67Gy）为可选而非必需；（2）高风险组，追加剂量照射被认为是必需的，且应考虑剂量增加至高于16Gy EQD2；包括年龄≤40岁、切缘接近、导管内成分广泛或三阴性表型的患者，或无论患者年龄手术切缘阳性的患者；（3）中风险组，追加剂量照射（10 - 16Gy EQD2）被认为是必需的，包括年龄小于40岁且无主要风险标准的患者、年龄大于40岁且小于50岁且无论有无任何风险因素的患者，或年龄大于50岁且有任何风险因素（切缘接近、肿瘤大小>3cm、导管内成分广泛、淋巴管侵犯、淋巴结侵犯、多中心或多灶性肿瘤、三阴性表型或新辅助化疗后有残留肿瘤）的患者。
这些建议可为浸润性乳腺癌WBI后使用追加剂量照射提供临床指导，适用于标准分割和低分割WBI。此外，它们应促进针对早期乳腺癌治疗中争议问题的进一步临床研究。
