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中华乳腺病杂志(电子版) ›› 2026, Vol. 20 ›› Issue (02) : 109 -114. doi: 10.3877/cma.j.issn.1674-0807.2026.02.006

综述

新辅助化疗乳腺癌患者术后放射治疗策略
刘天航, 刘志坤(), 张安度   
  1. 050011 石家庄,河北医科大学第四医院乳腺血液放疗科
  • 收稿日期:2025-02-19 出版日期:2026-04-01
  • 通信作者: 刘志坤

Postoperative radiotherapy strategies for breast cancer patients undergoing neoadjuvant chemotherapy

Tianhang Liu, Zhikun Liu(), Andu Zhang   

  • Received:2025-02-19 Published:2026-04-01
  • Corresponding author: Zhikun Liu
引用本文:

刘天航, 刘志坤, 张安度. 新辅助化疗乳腺癌患者术后放射治疗策略[J/OL]. 中华乳腺病杂志(电子版), 2026, 20(02): 109-114.

Tianhang Liu, Zhikun Liu, Andu Zhang. Postoperative radiotherapy strategies for breast cancer patients undergoing neoadjuvant chemotherapy[J/OL]. Chinese Journal of Breast Disease(Electronic Edition), 2026, 20(02): 109-114.

乳腺癌患者新辅助化疗(NAC)后不同初始分期、不同手术方式及病理反应的放射治疗指征与获益风险尚未达成共识。笔者系统梳理乳腺癌NAC后相关研究,认为对于初诊临床Ⅲ期及以上的乳房切除术后患者,无论病理反应如何,都推荐术后辅助放射治疗来降低局部区域复发率和提高生存率;NAC患者保留乳房手术后均需要全乳放射治疗;临床N2~3期、病理腋窝淋巴结阳性患者需要预防性照射区域淋巴结;临床N1期、NAC后ypN0期患者是否需要区域淋巴结照射尚无定论,建议参加临床研究或选择高危患者进行预防性照射。

表1 新辅助化疗乳腺癌患者乳房切除术后放射治疗的相关研究
作者 研究年限 研究类型 例数 临床分期 分组 治疗范围 治疗剂量(Gy) 结论
Huang等8 1974-2000 回顾性 676 Ⅰ~Ⅳ PMRT组 542例
非PMRT组 134例
胸壁+锁骨上下 50+10(加量具体不详) 非PMRT组患者10年LRR较PMRT组提高了11%
Liu等9 1998-2009 回顾性 1 560 Ⅱ~Ⅲ PMRT组 903例
非PMRT组 657例
胸壁+RNI 50.4 ⅢB/ⅢC、T3/T4、NAC后乳腺残存浸润性癌的患者,PMRT组患者OS显著延长
Huang等10 2000-2014 回顾性 1 813 Ⅱ~Ⅲ PMRT组 1 269例
非PMRT组 544例
胸壁+锁骨上下±腋窝±
内乳
40~60 PMRT显著改善ypN2-3患者5年OS;倾向于改善ypN0患者的LRC、ypN1患者的LRC和DFS、ypN2-3患者的LRC、DFS和OS
Mamounas等13(NSABP B-51) 2013-2020 前瞻性 1 641 Ⅱ~Ⅲ
ypN0
RNI组 820例
无RNI组821例
胸壁+RNI
RNI没有显著改善IBC-RFI、DRFI、DFS、OS
Chen等17 2000-2007 回顾性 104 Ⅱ~Ⅲ PMRT组 79例
非PMRT组 25例
胸壁+RNI 46~50 PMRT组5年累积LRR和DR低于非PMRT
Miyashita等18 2004-2009 回顾性 3 226 Ⅰ~Ⅲ PMRT组 1 000例
非PMRT组 2 226例
胸壁+RNI ypN2-3亚组的PMRT较非PMRT组的5年LRR-FS显著提高
Ohri等19 2004-2013 回顾性 29 270 Ⅰ~Ⅳ PMRT组 18 294例
非PMRT组 10 976例
胸壁+RNI >45 PMRT改善ypN3患者的5年OS
Lee等20 2006-2018 回顾性 368 PMRT组 276例
非PMRT组 92例
胸壁+RNI 50.4 5年LRR-FS及OS
差异无统计学意义
Zhang等21 2007-2015 回顾性 554 Ⅱ~Ⅲ PMRT组 399例
非PMRT组 155例
胸壁+RNI 在ypN1和ypN2-3中,PMRT组5年LRR显著降低,并延长患者的DFS
表2 乳腺癌患者新辅助化疗达pCR/ypN0的相关研究
作者 研究年限 研究类型 例数 临床分期 手术方式 分组 治疗范围 治疗剂量(Gy) 结论
Huang等8 1974-2000 回顾性 676 Ⅰ~Ⅳ 乳房切除 PMRT组 542例
非PMRT组 134例
胸壁+RNI 50+10(加量具体不详) 临床Ⅲ期或Ⅳ期经NAC达到pCR的患者,PMRT显著降低了10年LRR
Mamounas等13(NSABP B-51) 2013-2020 前瞻性 1 641 Ⅱ~Ⅲ
ypN0
乳房切除42%
保乳58%
RNI组 820例
无RNI组821例
胸壁/全乳±RNI
观察/全乳
RNI没有显著改善IBC-RFI、DRFI、DFS、OS
Daveau等27 1990-2004 回顾性 248 Ⅱ~Ⅲ
ypN0
保乳 RNI组 158例
无RNI组 90例
全乳+锁骨上下+内乳,瘤床加量25.3%
全乳,瘤床加量25.7%
(45~50)±(10~20)
(45~50)±(10~17.5)
5年LRR-FS和OS
差异无统计学意义
Schlafstein等28 2006-2015 回顾性 1 963 Ⅱ~Ⅲ
ypN0
保乳 RNI组 946例
无RNI组 1 017例
全乳+RNI
全乳
39~70(具体不详) 10年OS 差异无统计学意义
McGuire等31 1982-2002 回顾性 106 Ⅰ~Ⅲ
pCR
乳房切除 PMRT组 72例
非PMRT组 34例
胸壁+RNI (46~50)+10(加量具体不详) PMRT对cⅠ期或cⅡ期患者的10年LRR没有影响;PMRT对cⅢ期NAC后达pCR患者的LRR有显著的临床获益
Wang等32 2004-2016 回顾性 142
ypN0
乳房切除 PMRT组 110例
非PMRT组 32例
胸壁+锁骨上下 50~60 达pCR者PMRT组(n=38)的5年LR-FS和DFS显著高于非PMRT组
Shim等34 1998-2009 回顾性 151 Ⅱ~Ⅲ
ypN0
乳房切除 PMRT组 105例
非PMRT组 46例
胸壁+RNI 45~50 5年DFS、LRR-FS和OS差异无统计学意义
Dai等35 2012-2019 回顾性 116
ypN0
乳房切除 PMRT组 31例
非PMRT组 85例
胸壁+腋窝Ⅲ水平、锁骨上±内乳区 50 5年DFS、OS差异无统计学意义
Tan等36 2008-2019 回顾性 333 Ⅱ~Ⅲ
ypN0
乳房切除 PMRT组 189例
非PMRT组 144例
胸壁+RNI 50 5年LR-FS、DMFS、BCSS和OS差异无统计学意义
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