Kuntz L, Le Fèvre C, Hild C, Keller A, Gharbi M, Mathelin C, Pivot X, Noël G, Antoni D
Radiotherapy department, institut de cancérologie Strasbourg Europe (ICANS), 17, rue Albert-Calmette, 67200 Strasbourg, France.
Gynaecological and breast surgery department, institut de cancérologie Strasbourg Europe (ICANS), 17, rue Albert-Calmette, 67200 Strasbourg, France.
Gynecol Obstet Fertil Senol. 2021 Apr;49(4):255-265. doi: 10.1016/j.gofs.2020.12.010. Epub 2021 Jan 2.
Carcinomas in situ represent more than 15 to 20% of breast cancers. Radiotherapy of whole breast is part of the therapeutic standard and follows surgery. However, the indication of tumor bed irradiation is still controversial and heterogeneous according to international practice even though it is a very frequent clinical situation. The aim of this study is to define the indications of tumor bed irradiation in the context of ductal carcinomas in situ and to discuss accelerated partial irradiation of the breast.
The selected papers were published between 2015 and 2020 and included as MeSH terms "ductal carcinoma in situ" and "boost" for the analysis of tumor bed irradiation, and "ductal carcinoma in situ" and "accelerated partial breast irradiation" for the analysis of accelerated partial irradiation.
Boost was more often performed when risk factors for local recurrence were present, such as age less than 40 or 50 years old, clinical mode of detection, tumor size greater than 15 to 20mm, high nuclear grade, presence of necrosis, positive or insufficient surgical margins, associated atypical hyperplastic lesions, and lobular carcinoma in situ. Accelerated partial irradiation is an option for favorable or intermediate prognosis CCIS, further studies involving more patients are required.
Radiotherapy of the mammary gland in the context of DCIS has shown its effectiveness in terms of local and locoregional control of the disease, thus reducing in situ and infiltrating recurrences. However, the indication of operating bed irradiation is still debated, and the practice is very heterogeneous depending on the country. Another possible alternative for patients with a favorable prognosis and a small tumor bed volume would be IPA.
原位癌占乳腺癌的15%至20%以上。全乳放疗是治疗标准的一部分，在手术之后进行。然而，尽管肿瘤床照射是一种非常常见的临床情况，但根据国际惯例，其指征仍存在争议且不统一。本研究的目的是确定导管原位癌情况下肿瘤床照射的指征，并讨论乳腺加速部分照射。
所选论文发表于2015年至2020年之间，纳入的医学主题词为“导管原位癌”和“瘤床加量放疗”用于分析肿瘤床照射，以及“导管原位癌”和“乳腺加速部分照射”用于分析加速部分照射。
当存在局部复发的危险因素时，如年龄小于40或50岁、临床检测方式、肿瘤大小大于15至20毫米、高核分级、存在坏死、手术切缘阳性或不足、相关非典型增生性病变以及小叶原位癌时，更常进行瘤床加量放疗。加速部分照射是预后良好或中等的导管原位癌的一种选择，需要更多患者参与的进一步研究。
导管原位癌情况下的乳腺放疗已显示出其在疾病局部和区域控制方面的有效性，从而减少原位复发和浸润性复发。然而，手术床照射的指征仍存在争议，并且实践因国家而异。对于预后良好且肿瘤床体积较小的患者，另一种可能的选择是加速部分照射。
