乳腺癌术后放射治疗诱发肉瘤

目的　通过典型病例研究 ,了解乳腺癌术后放射治疗诱发肉瘤的一般规律及特点。方法　回顾性分析了 2例乳腺癌患者的详细病程。结果　 2例乳腺癌患者术后均曾行放射治疗 ,1例采用深部X线照射和辅助化疗 ,另 1例采用60 Co照射 ,未行辅助化疗。分别于治疗后 11年和 13年出现放射治疗野内的第 2原发癌 ,病理类型均是肉瘤。结论　对于放射治疗后 10年左右 ,单纯在放射治疗野内出现的异常情况 ,应警惕可能发生放射治疗诱发的肉瘤。     

Angiosarcoma associated with radiation therapy after treatment of breast cancer. Retrospective study on ten years

PurposeThe breast sarcoma induced by radiation therapy is rare but increasing, given the increased long-term survival of patients receiving radiation therapy. Fibrosarcoma, histiocytofibroma and angiosarcoma are the most common breast sarcoma. Angiosarcoma is the most common after breast cancer treated by radiation therapy, often diagnosed too late, with a severe prognosis and a high rate of recurrence. However, because of the low incidence of angiosarcoma associated with radiation therapy (AAR), the benefit of radiation therapy in breast cancer treatment outweighs the risk to develop angiosarcoma. The aim of this study is to evaluate these rare cases of AAR diagnosed in eastern Belgium in comparison to the data from the literature.Patients and methodsNine cases of AAR after radiation for breast ductal carcinoma were included in this retrospective study. AAR was diagnosed according to Cahan criteria between January 2007 and December 2016. Latency, incidence, management and prognosis are comparable to the literature.Results, conclusionThe median latency was 10 (4–24) years, the incidence of AAR in the East Belgian area was 0.09% of the patients irradiated on the same period. Patients were treated by surgery with wide local excision with or without reconstructive surgery, without radiotherapy and chemotherapy treatment. Kaplan-Meier analysis showed median overall survival of 61.8 months, patient survival of 55.6% at one year and 29.6% at five years. With the constant progress of medicine and its technologies, it would be possible to limit the occurrence of AAR or to diagnose it at an earlier stage.     

Sarcomas of the breast

Sarcomas of the breast are a rare group of heterogeneous mesenchymal tumors accounting for less than 1% of all breast malignancies. Owing to the rarity of the disease, current knowledge is mostly based on numerous case reports and relatively small retrospective series; unlike epithelial breast cancer, there is no high level evidence to support a standard of care for primary and/or adjuvant therapy. To overcome this relative shortage of data, most therapeutic strategies for breast sarcoma are extrapolated from current treatment for soft tissue sarcoma in other locations, mainly of the extremities and thoracic wall. In general, the therapeutic approach to sarcoma of the breast should be based on a multidisciplinary strategy including surgery, radiation to improve local control and systemic chemotherapy in selected patients. This review discusses the results of the key larger retrospective studies including data on incidence, etiology, presentation, diagnosis, management and prognosis of this challenging rare disease entity.     

Sarcoma as a second malignancy after treatment for breast cancer

: Second malignant neoplasms may be a consequence of radiotherapy for the treatment of breast cancer. Prior studies evaluating sarcomas as second malignant neoplasms in breast cancer patients have been limited by the numbers of patients and relatively low incidence of sarcoma. Using data from the Surveillance, Epidemiology and End Results registries, we evaluated the influence of radiation therapy on the development of subsequent sarcomas in cases with primary breast cancer.

: Cases with primary invasive breast cancer (n = 274,572) were identified in the Surveillance, Epidemiology and End Results Cancer Incidence Public-Use Database (1973–1997). The database was then queried to determine the cases developing subsequent sarcomas (n = 263). Eighty-seven of these cases received radiation therapy, and 176 had no radiation therapy. The cumulative incidence of developing secondary sarcoma and the survival post developing secondary sarcoma were determined by the Kaplan-Meier method.

: The occurrence of sarcoma was low, regardless of whether cases received or did not receive radiation therapy: 3.2 per 1,000 (SE [standard error] = 0.4) and 2.3 per 1,000 (SE = 0.2) cumulative incidence at 15 years post diagnosis, respectively (p = 0.001). Of the sarcomas occurring within the field of radiation, angiosarcoma accounted for 56.8%, compared to only 5.7% of angiosarcomas occurring in cases not receiving radiotherapy. The cumulative incidence of angiosarcoma at 15 years post diagnosis was 0.9 per 1,000 for cases receiving radiation (SE = 0.2) and 0.1 per 1,000 for cases not receiving radiation (SE < 0.1). Overall survival was poor for cases of sarcoma after breast cancer (27–35% at 5 years), but not significantly different between patients receiving or not receiving radiation therapy for their primary breast cancer.

: Radiotherapy in the treatment of breast cancer is associated with an increased risk of subsequent sarcoma, but the magnitude of this risk is small. Angiosarcoma is significantly more prevalent in cases treated with radiotherapy, occurring especially in or adjacent to the radiation field. The small difference in risk of subsequent sarcoma for breast cancer patients receiving radiotherapy does not supersede the benefit of radiotherapy.     

Radiation therapy as an adjunct to primary surgery in early stage breast cancer: biological and clinical rationale.

In spite of the widespread use of adjuvant endocrine and cytotoxic chemotherapy, a substantial proportion of patients with early-stage breast cancer eventually develop a distant disease recurrence. Local control also remains a clinically significant problem in subsets of patients. Whether improved local control through the use of postoperative radiation therapy would prevent distant dissemination has been much debated for several decades. Studies on the long-term outcome of systemically untreated breast cancer patients indicate that breast cancer in many patients is a local disease that can be cured by surgery or radiotherapy. Randomized trials of breast screening have also shown that a delay in effective local treatment is associated with an increased incidence of distant dissemination and death from to the disease. Data from individual randomized trials and overviews of postoperative radiation therapy have indicated that radiation therapy as an adjunct to primary surgery is associated with a decrease in distant dissemination and breast cancer death. This benefit may be translated into a substantial overall survival benefit, provided that the treatment technique avoids long-term cardiac side effects. In many of the older radiation therapy trials, such effects appear to have balanced the benefit in terms of a reduced incidence of distant disease among the patients allocated to radiotherapy.     

Leiomyosarcome de la paroi thoracique après radiothérapie pour cancer du sein. à propos d’un cas et revue de la littérature

Introduction

Adjuvant radiotherapy plays a significant role in preventing local failure in women treated for early stage breast cancer. The radiation-induced sarcoma is a late and exceptional complication of breast cancer radiotherapy, occurs in 0,23% of cases.

Case presentation

We report a case of a 54 year-old women with radiation-induced Leiomyosarcoma of the chest wall occurred 13 years after definitive treatment of breast cancer.

Conclusion

The radiation-induced sarcoma is characterized by a poor prognosis and a high rate of recurrence. The diagnosis for most patients is late and treatment remains ineffective.     

Role of radiotherapy in sarcoma of the breast--a retrospective review of the M.D. Anderson experience.

BACKGROUND: The role of adjuvant radiotherapy for sarcoma of the breast, based on local extension of disease and patterns of failure, remains undefined because of the rarity of the disease presentation. METHODS: Fifty-nine cases of soft tissue sarcoma of the breast were retrospectively reviewed. Cystosarcoma phylloides was excluded from analysis. Surgical intervention consisted of segmental resection (n = 16) or mastectomy (n = 38); five patients underwent excisional biopsy. Adjuvant radiotherapy was administered in four patients following segmental resection and in 13 patients after mastectomy. Doses totaled 50 Gy in the majority of patients, and conventional criteria and radiotherapy techniques for adjuvant breast irradiation were used. RESULTS: None of the dissected axillary nodes contained metastatic tumor on pathologic review. Patterns of failure were evaluated. Tumor size (P < 0.03) and surgical margins (P < 0.002) were predictive of local failure (LF). Due to limited patient numbers, no statistical significance was identified with any treatment modality. Following mastectomy alone, LF occurred in 13 patients (34%) versus the 13% rate of LF with mastectomy and radiotherapy (P = NS). Distant metastases developed concurrently with the two local failures in the group that underwent mastectomy and radiation. After segmental mastectomy, LF occurred in 3 cases (25%) concurrent with distant metastases: no LF were noted after segmental mastectomy and radiation (P = 0.27). For all treatment groups, local recurrences were characterized as multiple and involved the chest wall. Local failure occurred in 60% of patients with positive surgical margins who did not receive adjuvant irradiation. Irrespective of surgical margins, over 75% of local recurrences developed among patients treated by surgery alone. CONCLUSIONS: The role of radiotherapy for breast sarcoma remains undefined due to the rarity of this disease presentation. This retrospective review failed to demonstrate a statistical benefit for the administration of adjuvant irradiation in sarcoma of the breast, probably because of limited patient numbers. Because large tumor size and positive surgical margins incur a higher risk for LF, radiotherapy is probably indicated in these cases. Axillary dissection obligates the radiotherapist to treat the axilla in order to include all tissues in the surgical bed, and should be avoided to reduce potential treatment related morbidity. Established therapeutic principles and techniques used for both soft tissue sarcoma and breast cancer should continue to be applied.     

Surgical and adjuvant radiation therapy of resectable retroperitoneal soft tissue sarcomas in adults.

Primary soft tissue sarcoma of the retroperitoneum is a rare disease. A series of 11 evaluable adult patients with retroperitoneal soft tissue sarcomas is reported. These patients were treated with complete surgery and adjuvant radiation therapy (total dose from 50 to 64 Gy) using an 18 MeV linear accelerator. After a median follow-up of 48 months (range, 6-84), 4 patients had a local-regional recurrence, 3 had distant metastases, and 4 died of progressive disease. Four-year estimated disease-free survival was 54.5% and overall survival was 70%. Treatment was well tolerated by most patients: 7 patients experienced moderate gastrointestinal toxicity, mainly nausea and diarrhea, during radiotherapy; 2 cases had weight loss > 15% at the end of the therapy; and chronic ileitis was observed in 2 cases. We conclude that adjuvant radiotherapy seems to reduce the incidence of local-regional recurrences in these patients. No radiation-induced irreversible injury was observed, but one young woman had amenorrhea after radiotherapy. Controlled clinical trials are warranted to define the role and effectiveness of adjuvant radiotherapy and/or chemotherapy in retroperitoneal soft tissue sarcomas.     

The incidence and clinical characteristics of bronchiolitis obliterans organizing pneumonia syndrome after radiation therapy for breast cancer

STUDY OBJECTIVE: Bronchiolitis obliterans organizing pneumonia (BOOP) syndrome after adjuvant radiation therapy for breast cancer has been recently recognized. However, the precise incidence of this syndrome remains to be determined. The aim of this study was to clarify the incidence and clinical characteristics of radiation-induced BOOP syndrome. METHODS: We conducted a retrospective analysis of 206 consecutive patients wit breast cancer undergoing tangential-field radiation therapy at our institution from 1992 to 2002. RESULTS: Among the patients, five (2.4%) developed BOOP syndrome. These five patients began with flu-like symptoms 2-7 months after the completion of radiation therapy. Four of them had received tamoxifen, an estrogen receptor antagonist, and the other one underwent cytotoxic chemotherapy. Their chest radiographs revealed peripheral alveolar opacities with migration outside the irradiated fields. Increased lymphocyte counts and elevated CD4/CD8 ratios were observed in the bronchoalveolar lavage fluid. Transbronchial biopsy revealed organizing pneumonia. The serum levels of KL-6, a marker of interstitial pneumonia, did not increase in any patients. Treatment with corticosteroids resulted in a rapid improvement, but two patients relapsed after the cessation of corticosteroids. CONCLUSIONS: These results suggest that BOOP syndrome after tangential-field radiation therapy for breast cancer is not rare and more attention should be directed to this condition as a radiation-induced pulmonary toxicity.     

Timing of adjuvant systemic therapy and radiotherapy after breast-conserving surgery and mastectomy

In the last two decades, systemic adjuvant treatment for breast cancer, in association with radiotherapy, has been shown to prolong disease-free survival and overall survival in patients with operable breast tumors. So far, the optimal sequence of systemic therapy and radiotherapy for breast cancer patients after conservative surgery or mastectomy is unclear. Several retrospective analyses showed a possible detrimental effect on local regional recurrence rates when radiation therapy is delayed after chemotherapy. On the other hand, delaying chemotherapy after radiotherapy may increase the risk of distant failure and affect the survival. Concurrent administration of targeted treatment (e.g. non-anthracycline/taxane containing chemotherapy, trastuzumab, endocrine therapy) with radiotherapy is considered a valid option. A “tailored” approach on sequencing of chemotherapy and radiotherapy which takes into account various variables, such as histological and biological features of the tumor, as well as the patient status and the treatment modality is required in order to optimize the delivery of adjuvant treatments. This review focuses on the effects of timing of chemotherapy–radiotherapy and risks of relapse, in terms of locoregional and distant recurrence in patients with operable breast cancer.     

Personnalisation de la dose,du volume et du fractionnement de la radiothérapie du sein

Randomized trials demonstrated similar overall survival between mastectomy and breast-conservative surgery followed by adjuvant radiation therapy. Breast-conservative surgery, with adjuvant radiation therapy, with or without neoadjuvant systemic therapy has become the standard of care for women with early or locally advanced breast cancer. Nevertheless, certain cardiac, lung or cutaneous toxicities may alter the long-term body image and the quality of life of a limited number of patients who consider having had “overtreatment” or treatment outside the best knowledge of science. In case of low-risk breast cancer, several trials have evaluated the carcinologic outcome in absence of radiation therapy after breast-conservative surgery. Local recurrences increased in case of breast-conservative surgery alone but without impact on overall survival. Multiple debates have emerged in order to select the most appropriate evaluation criteria. Finally, a large consensus has considered that reducing local recurrences is important but with modern technologies and after identifying patients of individual radiosensitivity. Indeed, in case of a low absolute risk of local recurrence, radiation therapy techniques have been developed to allow a focal treatment especially for patients with high risk of developing late effects. This kind of compromise takes into account the reduction risk of local recurrences but also the probability of developing radiation-induced cutaneous sequelae. In the same way, for patients considered at high risk of recurrence, the huge volumes need specific techniques to better cover the targets while protecting the surrounding critic organs such as heart and lung. Intensity-modulated radiation therapy and the local high boost may help to decrease local recurrences of these more extended and aggressive diseases while considering the individual radiosensitivity that paves the way of long-term sequelae. In this article, we detail a personalized approach of breast radiation therapy considering the absolute risk of local recurrences and the probability of radiation-induced toxicity appearance.     

Timing of radiotherapy in breast cancer conserving treatment

The optimal timing and sequencing of adjuvant radiotherapy and chemotherapy after breast-conserving surgery for early invasive breast cancer is controversial. Several studies demonstrated that postoperative radiation therapy significantly reduces the incidence of breast recurrences. For patients who do not need systemic treatment, the interval between surgery and the start of radiotherapy should not exceed eight weeks. For node-positive and high-risk patients receiving breast-conserving treatment, adjuvant chemotherapy should be administered prior to radiotherapy, but the delay of radiation should not exceed 20-24 weeks. Side effects and complications of radiotherapy can be expected to increase when chemotherapy is administered concurrently. In particular, antracycline-based chemotherapy regimens increase the damage to heart muscle and coronary arteries: to avoid the risk of ischemic cardiovascular disease, radiotherapy must be performed after the end of systemic treatment.     

Radiation induced sarcoma following treatment of breast cancer

The occurrence of radiation induced sarcoma following treatment of breast cancer is rare. It has an average latency of ten years and it correlates with the dose and technique of radiation. The prognosis is poor due to delay in diagnosis. We present a case where a female patient developed a chondrosarcoma of sternoclavicular joint 19 years after radiotherapy for breast cancer.     

A Systematic Overview of Radiation Therapy Effects in Breast Cancer

A systematic review of radiation therapy trials in several tumour types was performed by The Swedish Council of Technology Assessment in Health Care (SBU). The procedures for evaluation of the scientific literature are described separately (Acta Oncol 2003; 42: 357-365). This synthesis of the literature on radiation therapy for breast cancer is based on data from 29 randomized trials, 6 meta-analyses and 5 retrospective studies. In total, 40 scientific articles are included, involving 41 204 patients. The results were compared with those of a similar overview from 1996 including 285 982 patients. The conclusions reached can be summarized as follows: There is strong evidence for a substantial reduction in locoregional recurrence rate following postmastectomy radiation therapy to the chest wall and the regional nodal areas.There is strong evidence that postmastectomy radiation therapy increases the disease-free survival rate.There are conflicting data regarding the impact of postmastectomy radiotherapy upon overall survival.There is strong evidence that breast cancer specific survival is improved by postmastectomy radiotherapy.There is strong evidence for a decrease in non-breast cancer specific survival after postmastectomy radiotherapy.There is some evidence that overall survival is increased by optimal postmastectomy radiation therapy.There is strong evidence that postmastectomy radiotherapy in addition to surgery and systemic therapy in mainly node-positive patients decreases local recurrence rate and improves survival.There is moderate evidence that the decrease in non-breast cancer specific survival is attributed to cardiovascular disease in irradiated patients.There are conflicting data whether breast conservation surgery plus radiotherapy is comparable to modified radical mastectomy alone in terms of local recurrence rate.There is strong evidence that breast conservation surgery plus radiotherapy is comparable to modified radical mastectomy alone in terms of disease-free survival and overall survival.There is strong evidence that postoperative radiotherapy to the breast following breast conservation surgery results in a statistically and clinically significant reduction of ipsilateral breast recurrences followed by diminished need for salvage mastectomies.There is strong evidence that the omission of postoperative radiotherapy to the breast following breast conservation surgery has no impact on overall survival. In one meta-analysis including three randomized studies a survival advantage is demonstrated by Bayesian statistics.There is strong evidence that the addition of a radiation boost after conventional radiotherapy to the tumour bed after breast conservation surgery significantly decreases the risk of ipsilateral breast recurrences but has no impact on overall survival after short follow-up.There is strong evidence for the use of postoperative radiotherapy to the breast following breast conservation surgery for DCIS (ductal breast cancer in situ). Radiotherapy leads to a clinically and statistically significant reduction of both non-invasive and invasive ipsilateral breast recurrences.There is insufficient evidence to define the optimal integration of systemic adjuvant therapy and postoperative radiotherapy.There are limited data on radiotherapy-related morbidity in breast cancer. No conclusions can be drawn.     

A systematic overview of radiation therapy effects in breast cancer

A systematic review of radiation therapy trials in several tumour types was performed by The Swedish Council of Technology Assessment in Health Care (SBU). The procedures for evaluation of the scientific literature are described separately (Acta Oncol 2003; 42: 357-365). This synthesis of the literature on radiation therapy for breast cancer is based on data from 29 randomized trials, 6 meta-analyses and 5 retrospective studies. In total, 40 scientific articles are included, involving 41 204 patients. The results were compared with those of a similar overview from 1996 including 285 982 patients. The conclusions reached can be summarized as follows: There is strong evidence for a substantial reduction in locoregional recurrence rate following postmastectomy radiation therapy to the chest wall and the regional nodal areas. There is strong evidence that postmastectomy radiation therapy increases the disease-free survival rate. There are conflicting data regarding the impact of postmastectomy radiotherapy upon overall survival. There is strong evidence that breast cancer specific survival is improved by postmastectomy radiotherapy. There is strong evidence for a decrease in non-breast cancer specific survival after postmastectomy radiotherapy. There is some evidence that overall survival is increased by optimal postmastectomy radiation therapy. There is strong evidence that postmastectomy radiotherapy in addition to surgery and systemic therapy in mainly node-positive patients decreases local recurrence rate and improves survival. There is moderate evidence that the decrease in non-breast cancer specific survival is attributed to cardiovascular disease in irradiated patients. There are conflicting data whether breast conservation surgery plus radiotherapy is comparable to modified radical mastectomy alone in terms of local recurrence rate. There is strong evidence that breast conservation surgery plus radiotherapy is comparable to modified radical mastectomy alone in terms of disease-free survival and overall survival. There is strong evidence that postoperative radiotherapy to the breast following breast conservation surgery results in a statistically and clinically significant reduction of ipsilateral breast recurrences followed by diminished need for salvage mastectomies. There is strong evidence that the omission of postoperative radiotherapy to the breast following breast conservation surgery has no impact on overall survival. In one meta-analysis including three randomized studies a survival advantage is demonstrated by Bayesian statistics. There is strong evidence that the addition of a radiation boost after conventional radiotherapy to the tumour bed after breast conservation surgery significantly decreases the risk of ipsilateral breast recurrences but has no impact on overall survival after short follow-up. There is strong evidence for the use of postoperative radiotherapy to the breast following breast conservation surgery for DCIS (ductal breast cancer in situ). Radiotherapy leads to a clinically and statistically significant reduction of both non-invasive and invasive ipsilateral breast recurrences. There is insufficient evidence to define the optimal integration of systemic adjuvant therapy and postoperative radiotherapy. There are limited data on radiotherapy-related morbidity in breast cancer. No conclusions can be drawn.     

Radiation therapy in the treatment of endometrial stromal sarcoma

OBJECTIVE: The efficacy of radiation therapy in the treatment of endometrial stromal sarcoma (ESS) is still not clear. We report our results over an 18-year period in comparison to data from literature concerning adjuvant radiation therapy and other treatment modalities. PATIENTS AND METHODS: During 1981-1998, 21 patients with ESS were treated at General Hospital Vienna. The age of the patients ranged between 44-76 years (median: 65 yr). The 1989 FIGO classification for endometrial carcinoma was used in this study retrospectively. Eleven patients presented in Stage I, 1 in Stage II and 5 in Stage III. Four patients had Stage IV tumors or recurrences. The majority of patients (66.7%) had a Grade 3 tumor. Seventeen patients were treated in a curative intent. Fifteen patients were referred for postoperative radiotherapy after hysterectomy. Thirteen of them received a combined radiotherapy. Two patients were referred for primary radiotherapy. They received a combined radiotherapy. Four patients were referred for radiotherapy with a palliative intent. Twenty patients received external beam therapy (EBT) in daily fractions of 1.6-2.0 Gy up to a total dose of 27-57 Gy to the pelvis. Seventeen patients received brachytherapy. RESULTS: Follow-up was 8 to 170 months (mean: 70.3 months, median: 64 months). Eleven patients are still alive, 10 without tumor and 1 with tumor. Ten patients are dead, 6 due to ESS, 1 due to breast cancer, and 3 due to intercurrent diseases. After adjuvant radiotherapy, 3 patients had tumor recurrences. All had distant metastases, and 1 had local failure additionally. Two patients with primary treatment died due to intercurrent disease without tumor. The overall actuarial survival and the disease-specific survival rates were 63.4% and 80.9% after 5 years and 52.8% and 80.9% after 10 years. The overall local control rate was 93.8% after 5 years. Four patients treated with a palliative intent showed partial response. Three patients died rapidly due to tumor. One patient with a Grade 1 tumor is still alive 12 months after treatment. CONCLUSION: In our experience, surgery and adjuvant radiation therapy are most effective treatments for patients with ESS due to the excellent local control in all stages and the good disease-specific survival in early stages.     

Combination of anti-estrogenic therapy with radiation in breast cancer: simultaneous or sequential treatment?

Adjuvant radiotherapy and adjuvant endocrine therapy are commonly given to patients with invasive breast cancer or with ductal carcinoma in situ (DCIS). Although both therapies have been well established through a number of randomized studies, little is known about a possible interaction of both treatment modalities if they are given simultaneously. A number of in vitro studies indicated that tamoxifen treatment might reduce the intrinsic radiosensitivity of MCF-7 breast cancer cells. Conversely, estradiol treatment increased the intrinsic radiosensitivity of MCF-7 cells. This phenomenon has not been found in clinical studies. Retrospective analyses of prospectively randomized clinical studies did not indicate an antagonistic effect of tamoxifen on the effectiveness of ionizing radiation (XRT), since local control has been consistently higher when XRT was combined with tamoxifen, compared to treatment with XRT alone, regardless of whether tamoxifen was started simultaneously with radiotherapy or after completion of radiotherapy. Currently there are no clinical data available that would suggest an adverse effect of adjuvant tamoxifen treatment started prior to or simultaneously with radiotherapy in breast cancer or DCIS. However, since an antagonistic effect of tamoxifen and simultaneous chemotherapy has been reported recently, the issue of simultaneous.     

早期乳腺癌保乳术后未行放疗原因调查与分析

目的 调查和分析乳腺癌保乳手术患者未进行术后放疗的原因。方法 对2012-2016年在本院保乳手术而未行术后辅助放疗的55例患者未接受放疗的临床病理特征和社会经济原因分析。结果 55例未放疗患者中25例因低的局部复发风险,12例因经济或家庭原因,12例恐惧放疗不良反应,5例基层医师未建议放疗。另外有多发远处转移3例,并发甲状腺癌3例未行放疗。结论 低的局部复发风险是未作术后放疗的主要原因,其次是患者担心放疗不良反应和经济原因。通过患者教育和医保可能提高术后放疗的依从性。     

Radiotherapy in breast cancer.

This review focuses on four aspects of radiotherapy in the treatment of breast cancer. The most controversial area is the treatment of ductal carcinoma in situ. Recent studies exploring breast-conserving surgery with and without radiation are outlined. Although no consensus exists on the recent studies, the emergence of ductal carcinoma in situ as a cancer with both significant pathologic subtypes and significant differences in clinical presentation is clear. Concerning the role of radiation in invasive breast cancer, all reports indicate continuation of the earlier observed success. Predictors for recurrence, the diagnosis of recurrence, and the relationship of an apparent isolated local recurrence with the eventual development of distant metastatic disease are reviewed. The outcome of treatment with breast-conserving surgery in radiation in unusual situations is also presented, including patients with silicone prostheses, those presenting with an axillary mass and occult breast disease, and those with multiple primary tumors in the same breast. The clinical evidence continues to support radiation delivered after mastectomy in patients who are at high risk for locoregional recurrence. Systemic adjuvant chemotherapy alone does not appear to prevent many of these recurrences. With the improved local control following treatment with both adjuvant systemic therapy and comprehensive postoperative radiation, preliminary reports are also documenting advantages in terms of disease-free survival.     

The role of post-operative radiotherapy in the treatment of operable breast cancer

Summary In current practice, the management of early stage breast cancer involves a multidisciplinary cooperation among surgeons, radiation therapists, and medical oncologists. The goals of local treatment in this setting are to secure tumor control and to identify patients who are to be treated with adjuvant systemic therapy. For patients treated by mastectomy, the value of post-operative radiotherapy in primary treatment remains controversial. In this review, we examine the evolution of treatment philosophies for operable breast cancer and the results from recent clinical studies in an attempt to assess the current role of post-operative radiotherapy.