Forster Tobias, Köhler Clara Victoria Katharina, Debus Jürgen, Hörner-Rieber Juliane
Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany.
Heidelberg Institute of Radiation Oncology (HIRO), Heidelberg, Germany.
Breast Care (Basel). 2020 Apr;15(2):136-147. doi: 10.1159/000506254. Epub 2020 Feb 21.
Breast-conserving therapy including lumpectomy and adjuvant whole breast irradiation (WBI) has become the standard therapy for early-stage breast cancer (EBC). Without WBI, the recurrence rate is significantly increased. However, when selecting patients at a low a priori risk of local recurrence only a small breast-cancer-specific mortality benefit, but no overall survival improvement, was detected for WBI. As most recurrences occur close to the lumpectomy cavity, accelerated partial breast irradiation (APBI) delivered exclusively to a limited volume of tissue around the initial lumpectomy site, has gained increased attention and is now discussed as an alternative to WBI for selected EBC patients.
Numerous techniques for APBI (interstitial brachytherapy, external beam-based APBI, intraoperative radiotherapy, MR-guided radiotherapy) allow treatment delivery in a shorter period of time, and radiation oncologists expect to further reduce side effects by using these new techniques, with improvements in cosmetics and quality of life. In this review, we aim to describe the existing evidence for the feasibility and effectiveness of different APBI techniques used in modern radiotherapy.
APBI has provided outcomes similar to WBI combined with potentially reduced toxicity. While appropriate patient selection persists to be crucial for acceptable recurrence rates, the precise definition of patients suitable for APBI remains a matter of discussion. As long-term data are often still lacking, special attention should be paid to late side effects and long-term outcomes. Decision-making on appropriate treatment techniques should take into account not only local control rates, but also the impact on the patient's quality of life.
保乳治疗，包括肿块切除术和辅助性全乳照射（WBI），已成为早期乳腺癌（EBC）的标准治疗方法。若无WBI，复发率会显著增加。然而，在选择局部复发先验风险较低的患者时，仅发现WBI对乳腺癌特异性死亡率有微小益处，但对总生存率无改善。由于大多数复发发生在肿块切除腔附近，仅对初始肿块切除部位周围有限体积的组织进行加速部分乳腺照射（APBI），已受到越来越多的关注，目前被讨论作为某些EBC患者WBI的替代方案。
APBI的多种技术（组织间近距离放疗、基于外照射的APBI、术中放疗、磁共振引导放疗）可在更短时间内完成治疗，放疗肿瘤学家期望通过使用这些新技术进一步减少副作用，同时改善美容效果和生活质量。在本综述中，我们旨在描述现代放疗中使用的不同APBI技术的可行性和有效性的现有证据。
APBI已提供了与WBI相似的结果，且潜在毒性可能降低。虽然合适的患者选择对于可接受的复发率仍然至关重要，但适合APBI的患者的精确定义仍存在争议。由于往往仍缺乏长期数据，应特别关注晚期副作用和长期结果。关于合适治疗技术的决策不仅应考虑局部控制率，还应考虑对患者生活质量的影响。
