早期乳腺癌保乳术后的放疗时机

早期乳腺癌保留乳房手术加放疗的疗效与根治术相同。对术后放疗时机的问题有一些回顾性和随机性研究，但无明确结论，近期的一些随机研究尚需要长期随访。总的来说，对于无需术后化疗的病人应尽早放疗，建议手术放疗间隔最好不超过8周。术后放疗、化疗顺序对疗效无显著影响，先放疗或先化疗均可以。对于腋窝淋巴结转移数较多的远地转移高危病人，术后可先做辅助化疗，但放疗不应延迟到术后7个月以后。如果手术切缘阳性，放疗应尽早开始。同步放化疗可以在不延迟放化疗的基础上提高局部疗效，但疗效提高有限，同时会增加急性和晚期毒副作用，不宜作为常规治疗。特殊病人需要使用时，应选择有效低毒的化疗方案，以降低治疗带来的急性毒副作用和晚期并发症。缩短放疗总时间对需要化疗的病人可以缩短手术到化疗的时间间隔，目前可行的方式有大分割放疗和乳腺瘤床同步补量技术。缩短放疗总时间是否能对疗效改善有影响，有待于临床资料证实。

The timing of radiotherapy for early-stage breast cancer after breast-conserving surgery

Breast-conserving surgery plus postoperative breast radiotherapy is considered the standard treat- ment for early-stage breast cancer.There are a few data on the timing and sequencing of adjuvant ra- diotherapy and chemotherapy after breast conserving surgery,including retrospective and randomized clinical studies.However,the optimal timing of radiotherapy has not yet been identified.Radiother- apy should be initiated early after surgery for patients who do not need chemotherapy.The surgery-ra- diotherapy interval is better not beyond 8 weeks.The outcome of patients with breast cancer was not associated with the sequencing of adjuvant radiotherapy and chemotherapy after breast conserving sur- gery.For patients with more positive nodes and others who have a high risk of distant metastases, chemotherapy could be performed between surgery and radiotherapy,but the surgery-radiotherapy in- terval is better not beyond 4 to 7 months.For patients with positive margins,radiotherapy should start as early as possible.Concurrent chemoradiotherapy is not considered standard due to treatment-re- lated acute and late toxicities.Hypofractionated radiotherapy or simultaneously tumor bed boost tech- nique can be used to shorten the overall radiation time,but there are scarce clinical data to confirm that shortened overall radiation time has a positive influence on treatment outcome.