Ahmed Muneer, Jozsa Felix, Douek Michael
Division of Surgery and interventional Science, University College London, Royal Free Hospital, 9th Floor (East), 2QG, 10 Pond St, London NW3 2PS, UK.
Nuffield Department of Surgical Sciences, University of Oxford, Botnar Research Centre, Windmill Road, Oxford OX3 7LD, UK.
Ecancermedicalscience. 2021 Jan 22;15:1175. doi: 10.3332/ecancer.2021.1175. eCollection 2021.
The use of neo-adjuvant radiotherapy (NRT) has been proven effective at improving cancer related outcome measures, including overall-survival (OS) in the management of solid cancers. However, its utilisation in breast cancer has not been explored to the extent of neo-adjuvant chemotherapy (NAC). The evidence for the application of NRT in breast cancer is evaluated.
PubMed, Embase and the Cochrane Library databases were searched systematically in August 2020 for studies that addressed the role of NRT in the treatment of breast cancer. Studies were deemed eligible if they reported on objective outcome measurements of OS, disease free-survival (DFS) or pathological complete response (pCR) and attained a satisfactory quality assessment.
A total of 23 studies reported upon 3,766 patients who had received NRT of which 3,233 also received NAC concurrently (neo-adjuvant chemo-radiotherapy (NCRT)). The pCR values ranged from 14% to 42%, 5-year DFS 61.4% to 81% and 5-year OS 71.6% to 84.2%. Complications were confined to radiation dermatitis with no cases of implant loss reported during breast reconstruction. The application of NRCT alone showed no significant difference in OS or DFS compared to NCRT followed by surgery.
Numbers of patients receiving exclusively NRT is small. However, NCRT is oncologically safe with a low side-effect profile including preceding breast reconstruction. Potential benefits include precise cancer volume targeting, chemosensitisation, elimination of delays in adjuvant therapies and alternatives to chemotherapy in oestrogen receptor positive patients. These factors warrant further exploration within randomised controlled-trials.
新辅助放疗（NRT）已被证明在改善癌症相关结局指标方面有效，包括实体癌治疗中的总生存期（OS）。然而，其在乳腺癌中的应用尚未像新辅助化疗（NAC）那样得到充分探索。本文对NRT在乳腺癌中应用的证据进行评估。
于2020年8月系统检索了PubMed、Embase和Cochrane图书馆数据库，以查找探讨NRT在乳腺癌治疗中作用的研究。若研究报告了OS、无病生存期（DFS）或病理完全缓解（pCR）的客观结局测量指标且质量评估令人满意，则被视为合格。
共有23项研究报告了3766例接受NRT的患者，其中3233例同时接受了NAC（新辅助放化疗（NCRT））。pCR值范围为14%至42%，5年DFS为61.4%至81%，5年OS为71.6%至84.2%。并发症仅限于放射性皮炎，乳房重建期间未报告植入物丢失的病例。与NCRT后手术相比，单独应用NRCT在OS或DFS方面无显著差异。
单纯接受NRT的患者数量较少。然而，NCRT在肿瘤学上是安全的，副作用较小，包括在乳房重建之前。潜在益处包括精确的癌灶体积靶向、化疗增敏、消除辅助治疗延迟以及为雌激素受体阳性患者提供化疗替代方案。这些因素值得在随机对照试验中进一步探索。
