不同国家和组织乳腺癌全乳腺切除术后辅助放疗指南的差异

目的:探讨不同国家和组织乳腺癌全乳腺切除术后辅助放疗指南的差异。方法:选择2001年-2014年不同国家和组织发布的乳腺癌全乳腺切除术后辅助放疗的指南进行分析。结果:各个指南基本同意对腋窝淋巴结转移≥4个的患者行术后辅助放疗，腋窝淋巴结1～3个转移的患者属于建议放疗的指征，T3N0期以及切缘近或切缘阳性的术后放疗存在争议。胸壁和锁骨上下区是最常见的照射靶区，对于腋窝淋巴结1～3个转移的患者锁骨上区照射存在争议，内乳区淋巴结照射亦存在争议。结论:目前关于乳腺癌全乳腺切除术后辅助放疗的指征及靶区仍存在较多争议，对于国人的放疗指征及靶区仍需要进一步的探索以规范乳腺癌的辅助治疗选择。

A comparison of international breast cancer adjuvant radiotherapy guidelines after mas-tectomy

Objective:To analyze the difference of international breast cancer adjuvant radiotherapy guidelines of postmastectomy.Methods:Analyzed the adjuvant radiotherapy guidelines of postmastectomy in different countries and organizations from 2001 to 2014.Results:All guidelines generally agreed with the postmastectomy radiotherapy(PMRT) for patients with 4 or more positive lymph nodes,PMRT was strongly consider for patients with 1~3 positive lymph nodes.The PMRT in T3N0 primary tumors,close or positive margins had related controversies.Chest wall,supraclavicular and infraclavicular area are the most common target volume of PMRT.Other related controversies,PMRT in the setting of irradiation of supraclavicular area for patients with 1~3 positive lymph nodes,internal mammary lymph node irradiation.Conclusion:Indications and target volume of PMRT are still more controversial.The further study in Chinese women is necessary and can help to standardize the adjuvant treatment of breast cancer.