Gasparri Maria Luisa, Kaidar-Person Orit, Gentilini Oreste Davide, de Boniface Jana, Kuehn Thorsten, Poortmans Philip
Centro di Senologia della Svizzera Italiana, Ospedale Regionale di Lugano, Lugano, Switzerland.
Department of Gynecology and Obstetrics, Ente Ospedaliero Cantonale, Centro di Senologia della Svizzera Italiana, Lugano, Switzerland.
Radiat Oncol J. 2024 Dec;42(4):308-318. doi: 10.3857/roj.2024.00248. Epub 2024 Dec 16.
After primary systemic therapy (PST), agreement on the extent of locoregional therapy is lacking in breast cancer patients who convert from a node-positive to a node-negative status. The aim of this survey was to investigate radiation therapy approaches after PST according to different axillary surgical strategies and disease responses.
The European Breast Cancer Research Association of Surgical Trialists developed a web-based survey containing 39 questions on locoregional management based on clinical scenarios in initially node positive breast cancer patients undergoing PST. Twelve international breast cancer societies distributed the link to breast surgeons and radiation oncologists.
Responses from 349 breast specialists were recorded, 72 of whom (20.6%) were radiation oncologists from 17 countries. Nodal status at diagnosis informed the decision for postoperative regional nodal irradiation (RNI) for 44/72 (61.1%) responders. RNI in node positive patients having undergone axillary lymph node dissection (ALND) is delivered in selected cases by 30/72 (41.7%) responders and systemically recommended by 26/72 (36.1%) responders. In case of macrometastases found on ALND, 43/72 (59.7%) responders always deliver RNI. In case of micrometastases in the sentinel lymph node(s) or targeted lymph node(s), 45/72 (62.5%) responders prefer RNI to completion ALND. A majority of responders (59.7%) determine the target volume for RNI according to European Society for Radiotherapy and Oncology guidelines. Significant heterogeneity was observed regarding nodal basins and volumes of interest for dose coverage by RNI.
There is significant heterogeneity in radiation-therapy delivered to the axilla after PST. A more standardized approach engaging both radiation oncologists and breast surgeons will help to optimize the harm-benefit equilibrium of axillary surgery and RNI.
在接受一线全身治疗（PST）后，对于从淋巴结阳性转为淋巴结阴性的乳腺癌患者，局部区域治疗的范围尚未达成共识。本调查的目的是根据不同的腋窝手术策略和疾病反应，研究PST后的放射治疗方法。
欧洲乳腺癌外科试验研究协会开展了一项基于网络的调查，其中包含39个关于局部区域治疗的问题，这些问题基于接受PST的初始淋巴结阳性乳腺癌患者的临床情况。12个国际乳腺癌协会将该链接分发给乳腺外科医生和放射肿瘤学家。
记录了349名乳腺专科医生的回复，其中72名（20.6%）是来自17个国家的放射肿瘤学家。对于44/72（61.1%）的回复者，诊断时的淋巴结状态为术后区域淋巴结照射（RNI）的决策提供了依据。30/72（41.7%）的回复者在部分病例中对接受腋窝淋巴结清扫（ALND）的淋巴结阳性患者进行RNI，26/72（36.1%）的回复者则系统地推荐进行RNI。如果在ALND中发现大转移灶，43/72（59.7%）的回复者总是进行RNI。如果在前哨淋巴结或靶向淋巴结中发现微转移灶，45/72（62.5%）的回复者更倾向于进行RNI而非完成ALND。大多数回复者（59.7%）根据欧洲放射治疗与肿瘤学会指南确定RNI的靶区体积。在RNI的淋巴结区域和感兴趣的剂量覆盖体积方面观察到显著的异质性。
PST后腋窝放射治疗存在显著的异质性。一种让放射肿瘤学家和乳腺外科医生都参与的更标准化方法将有助于优化腋窝手术和RNI的利弊平衡。
