Department of Radiation Oncology, Cleveland Clinic, Taussig Cancer Institute, Cleveland, Ohio.
21st Century Oncology, Michigan Healthcare Professionals, Farmington Hills, Michigan.
Breast J. 2019 May;25(3):408-417. doi: 10.1111/tbj.13241. Epub 2019 Apr 4.
Following breast conserving surgery, the standard of care has been to deliver adjuvant radiation therapy directed to the whole breast (WBI) over a period of 3-7 weeks. Over the past decade, increasing data have supported the concept that treatment to the whole breast may not be required in selected patients, allowing for the emergence of partial breast irradiation (PBI). Multiple randomized trials with 5-10 years of follow-up have been published documenting the safety and efficacy associated with PBI using multiple techniques. Questions that remain to be answered include (a) what is the optimal PBI technique for each clinical scenario, (b) are there additional patients that can be effectively managed with PBI approaches, and (c) are there different techniques/dose schedules that allow for further reduction in treatment duration and/or toxicities? Partial breast irradiation represents a standard approach for appropriately selected patients. PBI provides comparable clinical outcomes to WBI while allowing for a reduction in the duration treatment and the potential for reduced toxicities. Future studies may also help to better define which patients require no radiation, PBI, hypofractionated WBI or conventional WBI, based upon patient, clinical, pathologic features as well as potentially using tumor genetics.
保乳手术后，标准的治疗方法是在 3-7 周内对整个乳房（WBI）进行辅助放射治疗。在过去的十年中，越来越多的数据支持这样一种观点，即对于某些选定的患者，可能不需要对整个乳房进行治疗，可以采用部分乳房照射（PBI）。已经发表了多项随机试验，随访时间为 5-10 年，这些试验记录了使用多种技术进行 PBI 的安全性和有效性。仍有待回答的问题包括：（a）对于每种临床情况，哪种 PBI 技术是最佳的；（b）是否有更多的患者可以通过 PBI 方法有效治疗；以及（c）是否有不同的技术/剂量方案可以进一步缩短治疗时间和/或降低毒性？部分乳房照射是为适当选择的患者提供的标准治疗方法。PBI 提供与 WBI 相当的临床结果，同时可以减少治疗时间，并有可能降低毒性。未来的研究也可能有助于更好地根据患者、临床和病理特征，以及可能使用肿瘤遗传学，定义哪些患者不需要放疗、PBI、WBI 部分分割或常规 WBI。
