乳腺癌保乳术后加速部分乳腺照射研究进展

保乳手术加术后全乳腺放疗(whole breast irradiation, WBI)已成为早期乳腺癌的标准治疗模式之一, 但是传统的WBI照射范围大, 疗程长。近年来, 缩小照射范围、缩短总疗程的加速部分乳腺照射(accelerated partial breast irradiation, APBI)作为保乳术后WBI的替代治疗方法, 得到了广泛的认同。APBI常用的治疗方式有术中放疗、外照射和近距离放疗三种。术中放疗为保乳手术中给予一次性照射, 照射范围准确, 但是对设备的要求较高。外照射由专业的放疗科医师和物理师执行, 相对容易实现, 而且可以通过治疗计划系统使靶区剂量均匀分布。近距离治疗目前常用的有组织间插植和mammosite球囊治疗, mammosite设备技术简单、实施容易, 目前应用较广泛。然而, 由于APBI技术应用时间尚短、临床随访数据有限, 应用时必须进行严格的病例筛选以及合理的计划, 以降低局部复发的风险。 

Accelerated partial breast irradiation after breast conserving surgery:a review of techniques and progress

Breast-conserving surgery with postoperative whole-breast irradiation(WBI) has become one of the standard treatments for early breast cancer.However, traditional WBI has a large radiation field and lengthy course of treatment.Accelerated partial-breast irradiation(APBI) has been recognized as an alternative treatment to WBI.Three main techniques constitute APBI: intraoperative radiation therapy, external radiation therapy, and brachytherapy.Intraoperative radiation therapy involves the application of therapeutic levels of radiation during surgery.This technique allows for the exact delivery of radiation beams to the tumor bed; strict precision is observed for equipment in this technique.External radiation therapy is performed by radiotherapists and physicists.This technique is easy to implement.Furthermore, the target dose distribution can be achieved because of the implementation of a treatment planning system.Brachytherapy includes multi-catheter interstitial brachytherapy and mammosite therapy.Presently, mammosite therapy is widely used because of its facile procedure.However, clinical follow-up data are limited because of the short duration of APBI therapy.The selection of appropriate patients and optimal dosimetric distribution is needed before APBI application to reduce the risk of breast cancer recurrence.