5乳腺癌放射治疗面临的挑战余子豪.ppt

5乳腺癌放射治疗面临的挑战余子豪
一簇蓝色精灵的小确幸
CHENYING0907
乳腺肿块切除术后单独近距离治疗(TBRT) 和全乳腺照射(WBRT)的比较
（Polgar C et al. 2002)
Ⅲ期试验：
WBRT: Wallgren, et al.
5352
不同方案
14%
24%
Taghian, et al.
5758
不同方案
19-27%*
13%*
24-34%*
24-32%*
*：高分级及LVSI
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Guideline or Consensus
Consensus Statement on postmastectomy radiation therapy. IJROBP 1999; 44: 989.
Postmastectomy radiotherapy: clinical practice guidelines of the American Society of Clinical Oncology. JCO 2001; 19: 1539.
National Institutes of Health Consensus Development Conference Statement: adjuvant therapy for breast cancer. JNCI 2001; 93: 979.
EUSOMA Working Party. The curative role of radiotherapy in the treatment of operable breast cancer. Eur J Cancer 2002; 38: 1961-74.
Meeting highlights: updated international expert consensus on the primary therapy of early breast cancer. JCO 2003; 21: 3357-65.
Clinical practice guidelines for the care and treatment of breast cancer: 16,Locoregional postmastectomy radiotherapy. CMAT 2004; 170: 1263-73.
Meeting highlights: international expert consensus on the primary therapy of early breast cancer 2005. Ann Oncol 2005; 16: 1569-83.

上述文件均不推荐对LN+1-3患者作PMRT
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DBCG82 b&CLN+1-3组放疗疗效Overgaad M et al. Radiother Oncol 2007;82:247
DBCG82 b&c随机分组研究：-
入组病人：LN+和/或T3，T4肿瘤和/或皮肤及 深筋膜侵犯，总计3083例
亚组分析：淋巴结检测总数≥8，共1152例
治疗方法：改良根治术+全身辅助治疗
术后放疗：胸壁，内乳，锁骨上下 及
腋窝淋巴结区，48-50Gy/22-25次
结果：中位随访期18年（15-22年）
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CN+1-3 CN+≥4
RT(-) RT(+) RT(-) RT(+)
局部-区域复发率 27% 4% P< 51% 10% P<
15年生存率 48% 57% P< 12% 21% P<
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The recommendation for chest wall and supraclavicular irradiation in women with 1-3 involved axillary lymph nodes generated substantial controversy among panel members. Some panel members believe chest wall and supraclavicular irradiation should be used routinely after mastect