He Lin, Lv Yang, Song Yuhua, Zhang Biyuan
Breast Center B Ward, The Affiliated Hospital of Qingdao University, Qingdao, Shandong Province, People's Republic of China.
Department of Oncology, The PLA Navy Anqing Hospital, Anqing, Anhui Province, People's Republic of China.
Cancer Manag Res. 2019 Jun 28;11:5765-5775. doi: 10.2147/CMAR.S213663. eCollection 2019.
Radiotherapy can increase the cell cycle arrest that promotes apoptosis, reduces the risk of tumor recurrence and has become an irreplaceable component of systematic treatment for patients with breast cancer. Substantial advances in precise radiotherapy unequivocally indicate that the benefits of radiotherapy vary depending on intrinsic subtypes of the disease; luminal A breast cancer has the highest benefit whereas human epidermal growth factor receptor 2 (HER2)-positive and triple negative breast cancer (TNBC) are affected to a lesser extent irrespective of the selection of radiotherapy strategies, such as conventional whole-breast irradiation (CWBI), accelerated partial-breast irradiation (APBI), and hypofractionated whole-breast irradiation (HWBI). The benefit disparity correlates with the differential invasiveness, malignance, and radiosensitivity of the subtypes. A combination of a number of molecular mechanisms leads to the strong radioresistant profile of HER2-positive breast cancer, and sensitization to irradiation can be induced by multiple drugs or compounds in luminal disease and TNBC. In this review, we aimed to summarize the prognostic differences between various subtypes of breast tumors after CWBI, APBI, and HWBI, the potential reasons for drug-enhanced radiosensitivity in luminal breast tumors and TNBC, and the robust radioresistance of HER2-positive cancer.
放射治疗可增加促进细胞凋亡的细胞周期阻滞,降低肿瘤复发风险,已成为乳腺癌患者系统治疗中不可替代的组成部分。精确放射治疗取得的重大进展明确表明,放射治疗的获益因疾病的内在亚型而异;管腔A型乳腺癌获益最大,而无论采用何种放射治疗策略,如传统全乳照射(CWBI)、加速部分乳腺照射(APBI)和大分割全乳照射(HWBI),人表皮生长因子受体2(HER2)阳性乳腺癌和三阴性乳腺癌(TNBC)受到的影响较小。获益差异与各亚型的不同侵袭性、恶性程度和放射敏感性相关。多种分子机制共同作用导致HER2阳性乳腺癌具有较强的放射抗性,而管腔型疾病和TNBC中的多种药物或化合物可诱导对放疗的敏感性。在本综述中,我们旨在总结CWBI、APBI和HWBI后不同亚型乳腺肿瘤的预后差异,管腔型乳腺肿瘤和TNBC中药物增强放射敏感性的潜在原因,以及HER2阳性癌症强大的放射抗性。
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