Choi J Isabelle, Freedman Gary M, Guttmann David M, Ahmed Kamran, Gao Wendy, Walker Eleanor M, Harris Eleanor E, Gonzalez Victor, Ye Jason, Nead Kevin, Taunk Neil, Tadros Audree B, Dang Chau T, Daroui Parima, Novick Kristina
Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center and New York Proton Center, New York, NY.
Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
Am J Clin Oncol. 2025 Mar 1;48(3):111-121. doi: 10.1097/COC.0000000000001154. Epub 2024 Nov 14.
Recent literature has provided additional data to further individualize treatment recommendations on regional nodal irradiation (RNI) patient selection and delivery techniques, but controversies surrounding optimal RNI utilization remain, including radiation technique, modality selection, and internal mammary lymph node (IMN) inclusion. The American Radium Society (ARS) Breast Appropriate Use Criteria (AUC) Committee performed a systematic review and developed a consensus guideline to summarize recent data and provide evidence-based recommendations.
A multidisciplinary panel comprised of 15 members representing radiation oncologists, medical oncologists, and surgical oncologists specializing in the treatment of breast cancer conducted an analysis of the medical literature from January 1, 2011 to April 1, 2024. Modified Delphi methodology was used to rate the appropriateness of treatments for variants across 3 key questions.
Patients with intermediate-risk breast cancer, such as limited nodal involvement or large primary tumor size, are reasonable candidates for RNI, although a subset of patients with overall favorable clinicopathologic features may be considered for treatment de-escalation. Data on the use of advanced radiation techniques for RNI were limited in scope and strength, and the panel agreed that careful patient selection is needed when using these tools. Evidence suggests that the IMN should be included when delivering RNI given the absolute benefit demonstrated in multiple randomized trials.
A systematic review and evidence-based summary of recommendations are provided in these consensus guidelines from the ARS Breast AUC Committee to provide current comprehensive guidance on the optimal management of non-metastatic breast cancer patients being considered for RNI.
近期文献提供了更多数据，以进一步使区域淋巴结照射（RNI）患者选择和实施技术的治疗建议个体化，但围绕RNI最佳应用的争议仍然存在，包括放射技术、模式选择和内乳淋巴结（IMN）纳入。美国镭协会（ARS）乳腺合理使用标准（AUC）委员会进行了系统评价，并制定了共识指南，以总结近期数据并提供基于证据的建议。
一个由15名成员组成的多学科小组，包括专门治疗乳腺癌的放射肿瘤学家、医学肿瘤学家和外科肿瘤学家，对2011年1月1日至2024年4月1日的医学文献进行了分析。采用改良的德尔菲方法对3个关键问题的不同治疗方法的适宜性进行评分。
中度风险乳腺癌患者，如淋巴结受累有限或原发肿瘤较大，是RNI的合理候选者，尽管一部分临床病理特征总体良好的患者可考虑降低治疗强度。关于RNI使用先进放射技术的数据在范围和强度上有限，小组一致认为在使用这些工具时需要仔细选择患者。有证据表明，鉴于多项随机试验显示的绝对获益，在进行RNI时应纳入IMN。
ARS乳腺AUC委员会的这些共识指南提供了系统评价和基于证据的建议总结，以就考虑进行RNI的非转移性乳腺癌患者的最佳管理提供当前全面指导。
