Updated Breast Cancer Surveillance Recommendations for Female Survivors of Childhood, Adolescent, and Young Adult Cancer From the International Guideline Harmonization Group
Updated Breast Cancer Surveillance Recommendations for Female Survivors of Childhood, Adolescent, and Young Adult Cancer From the International Guideline Harmonization Group
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DOI：
10.1200/jco.20.00562
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发表时间：
2020-12-10
影响因子：
45.3
通讯作者：
Oeffinger, Kevin C.
中科院分区：
文献类型：
--
作者：
Mulder, Renee L.;Hudson, Melissa M.;Oeffinger, Kevin C.
目的随着新证据的出现，国际儿童癌症晚期影响指南协调小组更新了针对儿童、青少年和青壮年癌症女性幸存者的乳腺癌监测建议。指南小组更新了系统的文献综述，制定了证据摘要，评估了证据，并根据证据、临床判断和对监测干预的益处和危害的考虑更新了建议，同时在不同的医疗保健系统中实现了实施的灵活性。采用分级证据-决策框架将证据转化为建议。制定了幸存者信息表，向幸存者提供关于监测的潜在危害和好处的咨询。结果文献更新确定了新的研究结果，涉及处方中剂量胸部放射(10-19Gy射线)的影响，非胸部照射幸存者的辐射剂量-体积，蒽环类药物和烷化剂，以及卵巢功能对乳腺癌风险的影响。此外，关于霍奇金淋巴瘤幸存者的乳房X光检查和磁共振成像的表现指标，有来自前瞻性研究的新数据。修改后的建议包括对接受10GY或更大剂量胸部放射治疗的幸存者进行乳房X光检查和乳房磁共振成像(强烈建议)，以及在年轻时进行上腹部放射暴露乳房组织(中等建议)，至少每年进行一次，直至60岁。由于证据不一致，没有建议在没有胸部放射治疗的情况下对接受任何类型蒽环类药物治疗的幸存者进行常规乳腺癌监测。结论新发现的证据促使2013年制定的关于中等剂量胸部辐射和蒽环类药物暴露以及乳腺癌监测模式的建议发生了重大变化。(C)2020年美国临床肿瘤学会
PURPOSE As new evidence is available, the International Late Effects of Childhood Cancer Guideline Harmonization Group has updated breast cancer surveillance recommendations for female survivors of childhood, adolescent, and young adult cancer.METHODS We used evidence-based methods to apply new knowledge in refining the international harmonized recommendations developed in 2013. The guideline panel updated the systematic literature review, developed evidence summaries, appraised the evidence, and updated recommendations on the basis of evidence, clinical judgement, and consideration of benefits versus the harms of the surveillance interventions while attaining flexibility in implementation across different health care systems. The GRADE Evidence-to-Decision framework was used to translate evidence to recommendations. A survivor information form was developed to counsel survivors about the potential harms and benefits of surveillance.RESULTS The literature update identified new study findings related to the effects of prescribed moderate-dose chest radiation (10 to 19 Gy), radiation dose-volume, anthracyclines and alkylating agents in non-chest irradiated survivors, and the effects of ovarian function on breast cancer risk. Moreover, new data from prospective investigations were available regarding the performance metrics of mammography and magnetic resonance imaging among survivors of Hodgkin lymphoma. Modified recommendations include the performance of mammography and breast magnetic resonance imaging for survivors treated with 10 Gy or greater chest radiation (strong recommendation) and upper abdominal radiation exposing breast tissue at a young age (moderate recommendation) at least annually up to age 60 years. As a result of inconsistent evidence, no recommendation could be formulated for routine breast cancer surveillance for survivors treated with any type of anthracyclines in the absence of chest radiation.CONCLUSION The newly identified evidence prompted significant change to the recommendations formulated in 2013 related to moderate-dose chest radiation and anthracycline exposure as well as breast cancer surveillance modality. (C) 2020 by American Society of Clinical Oncology