THE ROLE OF RADIATION-THERAPY IN THE MULTIDISCIPLINARY MANAGEMENT OF RECURRENT AND METASTATIC BREAST-CANCER
THE ROLE OF RADIATION-THERAPY IN THE MULTIDISCIPLINARY MANAGEMENT OF RECURRENT AND METASTATIC BREAST-CANCER
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DOI：
10.1002/cncr.2820741334
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发表时间：
1994-07-01
期刊：
影响因子：
6.2
通讯作者：
MARCIAL, VA
中科院分区：
文献类型：
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作者：
MARCIAL, VA
乳腺癌是一种与10年复发率相关的疾病，在可手术但没有扩散到腋窝淋巴结的患者中，复发率为25%，在肿瘤已扩散到腋窝淋巴结的患者中，复发率为75%。据报道，在III期患者中，局部复发率接近50%。术后辅助性预防性放疗可以将局部复发率降低到10%以下。当乳腺癌切除术后局部复发时，需要进行治疗性放射治疗。它可以在至少50%的病例中实现肿瘤控制。当外科手术能在照射前将复发的肿瘤完全切除，且照射范围覆盖胸壁和相关的淋巴结区时，最佳条件存在。肿瘤切除后所需的放射剂量较低，局部肿瘤控制的机会较高。亚临床疾病的放射剂量必须为4500-5000cGy(180-200cGy)，已知肿瘤区域必须增加1000-1500cGy的剂量。远处转移的表现必须用于姑息治疗，除非是孤立的锁骨上转移，在这种情况下，根治性照射可以治愈。需要定义系统治疗在局部区域复发中的作用，以及在局部或远处乳腺癌复发的患者中发展系统化疗和局部放射治疗的最佳整合。
Carcinoma of the breast is a disease that is associated with 10-year recurrence rates of 25% in operable patients with no spread to the axillary nodes and 75% in patients in whom the tumor has extended to the axillary nodes. Locoregional recurrence rates of close to 50% have been reported in patients with Stage III disease.Adjuvant prophylactic postoperative irradiation can reduce locoregional recurrences to less than 10%. When locoregional recurrence occurs after mastectomy, therapeutic irradiation is required. It can achieve tumor control in at least 50% of cases. The best conditions exist when a surgical procedure can achieve gross removal of the recurrent tumor before irradiation and when the fields of irradiation encompass the chest wall and pertinent lymph node areas. The required dose of radiation is lower after excision of the tumor, and the chances of local tumor control are higher. The dose of radiation must be 4500-5000 cGy (fractions of 180-200 cGy) to the subclinical disease and a boost of 1000-1500 cGy added to the known tumor areas.Distant metastatic manifestations must be dealt with for palliative purposes, except in the case of isolated supraclavicular metastasis, where radical irradiation can achieve cure.The need exists for a definition of the role of systemic therapy for locoregional recurrence, and for the development of the optimal integration of systemic chemotherapy and local radiotherapy in patients with locoregional or distant breast cancer recurrences.