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中华乳腺病杂志(电子版) ›› 2018, Vol. 12 ›› Issue (01) : 50 -54. doi: 10.3877/cma.j.issn.1674-0807.2018.01.010

所属专题: 文献

综述

乳腺导管原位癌保留乳房手术后序贯放射治疗的研究进展
黄欣1, 陈畅1, 周易冬1, 茅枫1, 关竞红1, 林燕1, 钟颖1, 曹希1, 孙强1,()   
  1. 1. 100730 北京协和医院乳腺外科
  • 收稿日期:2017-04-11 出版日期:2018-02-01
  • 通信作者: 孙强
  • 基金资助:
    北京市科技计划资助项目(D161100000816005)

Sequential radiotherapy after breast-conserving surgery for breast ductal carcinoma in situ

Xin Huang1, Chang Chen1, Yidong Zhou1   

  • Received:2017-04-11 Published:2018-02-01
引用本文:

黄欣, 陈畅, 周易冬, 茅枫, 关竞红, 林燕, 钟颖, 曹希, 孙强. 乳腺导管原位癌保留乳房手术后序贯放射治疗的研究进展[J/OL]. 中华乳腺病杂志(电子版), 2018, 12(01): 50-54.

Xin Huang, Chang Chen, Yidong Zhou. Sequential radiotherapy after breast-conserving surgery for breast ductal carcinoma in situ[J/OL]. Chinese Journal of Breast Disease(Electronic Edition), 2018, 12(01): 50-54.

在过去的10年中,对于乳腺DCIS的局部治疗,保留乳房(简称保乳)手术得到了广泛的重视。目前,学者们认为保乳术后序贯放射治疗能够降低乳腺DCIS的局部复发风险,但是,一些研究者认为,对于本身低复发风险的患者而言,保乳术后序贯放射治疗可能存在过度治疗。笔者就乳腺DCIS保乳术后是否序贯放射治疗这一研究热点,总结了相关的回顾性研究、随机临床对照试验以及前瞻性队列研究,分析了乳腺DCIS保乳术后序贯放射治疗的获益与风险,最终发现乳腺DCIS保乳术后序贯放射治疗尚不能带来明确的生存获益,但是,对于局部复发风险较高的患者,放射治疗可以带来益处。而对于局部复发风险的判定目前常用的有以下3种方法:南加利福尼亚大学Van Nuys预后指数(USC/VNPI)、基于人口数据估测获益的评分表以及基于12基因的Oncotype DX DCIS评分系统。因此,笔者认为乳腺DCIS保乳术后是否序贯放射治疗应根据其复发风险决定。

表1 2篇DCIS患者保留乳房手术后序贯放射治疗的回顾性研究
表2 肿块单纯切除术对比肿块单纯切除术后序贯放射治疗的随机临床试验
表3 肿块单纯切除术对比肿块单纯切除术后放射治疗的同侧乳腺癌复发率(%)
表4 南加利福尼亚大学Van Nuys预后指数评价标准[22]
表5 预测乳腺导管原位癌患者能否从保留乳房手术后的放射治疗中获益的评分表[29]
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