Li Yun R, Barry Parul N
Department of Radiation Oncology, Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA, USA.
Department of Radiation Oncology, UPMC Hillman Cancer Center, University of Pittsburgh, Pittsburgh, PA, USA.
Ann Breast Surg. 2022 Dec 30;6. doi: 10.21037/abs-20-133.
Partial breast irradiation (PBI) has been increasingly accepted as a suitable component of breast conservation in the management of patients with early stage breast cancer, however the majority of existing studies have focused on the use of adjuvant or intra-operative techniques. Several early stage studies have more recently shown that PBI can be safely used in the pre-operative setting. Early data show similar local control without evidence of increased toxicity or worsening cosmesis, as compared to postoperative PBI or standard whole breast irradiation. While long term data are still maturing, pre-operative accelerated PBI (PAPBI) offers a number of possible clinical advantages including reducing the treatment field and increasing the number of patients eligible for PBI, identifying biomarkers of response to radiation, and improving the rates of breast conservation and treatment compliance. This review discusses key concepts and controversies surrounding PBI as it has increasingly been adopted in the US, Canada, and Europe, and introduces the concepts and early studies of PAPBI. In addition, we summarize ongoing clinical trials investigating PAPBI, review clinical benefits and challenges associated with PAPBI versus postoperative PBI, and discuss ongoing limitations as well as next generation technologies important to the implementation of PAPBI in the management of patients with early-stage localized breast cancer.
部分乳腺照射（PBI）已越来越多地被视为早期乳腺癌患者保乳治疗的合适组成部分，然而现有的大多数研究都集中在辅助或术中技术的应用上。最近一些早期研究表明，PBI可安全地用于术前治疗。早期数据显示，与术后PBI或标准全乳照射相比，其局部控制效果相似，且无毒性增加或美容效果恶化的迹象。虽然长期数据仍在完善中，但术前加速部分乳腺照射（PAPBI）具有一些可能的临床优势，包括缩小治疗范围、增加适合PBI的患者数量、识别对放疗反应的生物标志物以及提高保乳率和治疗依从性。本综述讨论了在美国、加拿大和欧洲越来越多地采用PBI时围绕它的关键概念和争议，并介绍了PAPBI的概念和早期研究。此外，我们总结了正在进行的研究PAPBI的临床试验，回顾了PAPBI与术后PBI相关的临床益处和挑战，并讨论了当前存在的局限性以及对在早期局限性乳腺癌患者管理中实施PAPBI很重要的下一代技术。
