Yarnold J R
Radiother Oncol. 1984 Aug;2(2):79-92. doi: 10.1016/s0167-8140(84)80043-2.
High-dose lymphatic irradiation is a contributory factor to the morbidity of treatment after local excision and high-dose radiotherapy for early stage breast cancer and may detract significantly from the cosmetic result. The apparent inability of lymphatic irradiation to influence the survival of patients with early stage breast cancer supports an argument for the selective avoidance of regional radiotherapy in a proportion of patients. Based on a review of the effects of lymphatic radiotherapy on lymphatic control, complications, cosmesis, survival and the effects of withholding lymphatic irradiation, recommendations are made for the selective treatment of patients at high risk of regional recurrence. In patients submitted to full axillary dissection, node negative patients require no lymphatic irradiation. After full axillary dissection radiotherapy is confined to the supraclavicular fossa in patients with heavy axillary involvement. A policy for patients having limited axillary dissection is discussed which identifies approximately 50% of patients as eligible for careful watch policy following local excision and high-dose radiotherapy to the primary disease.
大剂量淋巴照射是早期乳腺癌局部切除及大剂量放疗后治疗相关发病率的一个促成因素，且可能显著影响美容效果。淋巴照射对早期乳腺癌患者生存无明显影响，这支持了在部分患者中选择性避免区域放疗的观点。基于对淋巴放疗在淋巴控制、并发症、美容效果、生存以及不进行淋巴照射的影响等方面的综述，针对区域复发高危患者的选择性治疗提出了建议。对于接受全腋窝清扫的患者，淋巴结阴性患者无需进行淋巴照射。在全腋窝清扫后，腋窝受累严重的患者放疗局限于锁骨上窝。讨论了针对进行有限腋窝清扫患者的策略，该策略确定约50%的患者在局部切除及对原发疾病进行大剂量放疗后符合密切观察策略的条件。
