Morbidity related to axillary irradiation in the treatment of breast cancer
Morbidity related to axillary irradiation in the treatment of breast cancer
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DOI：
10.1080/028418600750013113
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发表时间：
2000-01-01
期刊：
影响因子：
3.1
通讯作者：
Dische, S
中科院分区：
文献类型：
--
作者：
Bentzen, SM;Dische, S
乳腺癌手术和放疗后一些最令人衰弱的发病率与腋窝治疗有关。这包括持续性手臂淋巴水肿、肩部活动受损和臂丛神经病。人们对这些临床终点的放射发病机制和临床放射生物学进行了大量的研究工作，这使得它们的严重性和发生率得以最小化。很明显，这些晚期终点的辐射剂量-反应关系非常睡眠。换句话说，即使精确剂量分割和物理剂量分布的微小变化也可能导致毒性的重大变化。特别是，在许多治疗方案中，使用了大于2Gy的剂量分数，而没有充分减少总剂量以避免增加后期效应。这很重要，因为许多现有文献报告了次优剂量分割方案和较差的放射治疗技术后的副作用。此类报告并不代表使用现代放射疗法可以实现的目标。英国乳房诉讼中发现了与回顾历史经验时遇到的问题有趣的相似之处，本文介绍了该诉讼的现状。此外，放疗后的发病率受到伴随手术和/或化疗的强烈影响，在设计整体治疗时应考虑到这一点。除了其他治疗方式外，有人认为其他外源因素也会影响放疗相关发病的风险。然而，患者的年龄以及（就淋巴水肿而言）肥胖是唯一已确定的因素。在这些情况下，不建议常规调整放疗剂量。目前的两项进展可能会加强放射治疗在乳腺癌治疗中的作用。前哨淋巴结活检可以在不进行腋窝淋巴结大手术切除的情况下进行淋巴结分期，这为腋窝治疗中放疗和手术的更优化组合提供了可能性。随着越来越多的癌症现在通过系统筛查计划被发现，这也将增加保守治疗的可能性，在大多数情况下，保守治疗涉及放射治疗。总之，提高对放射治疗后晚期后遗症的临床放射生物学的了解，可以设计出治疗有效的治疗方案和技术，同时保持严重晚期发病风险最小。
Some of the most debilitating morbidity after surgery and radiotherapy for breast cancer is related to treatment of the axilla. This includes persistent arm lymphoedema, impaired shoulder mobility and brachial plexopathy. Considerable research efforts have been carried out on the radiation pathogenesis and the clinical radiobiology of these clinical endpoints, which has enabled their severity and incidence to be minimized. It is clear that the radiation dose-response relationships For these late endpoints are very sleep. In other words, even small changes in the exact dose fractionation and physical dose distribution can cause major changes in toxicity. In particular, in many treatment schedules dose fractions larger than 2 Gy have been used without a sufficient reduction in total dose to avoid increased late effects. This is important, as much of the available literature reports side effects after suboptimal dose-fractionation schedules and inferior radiotherapy techniques. Such reports are not representative of what can be achieved using modern radiotherapy. An interesting parallelism to the problems encountered in reviewing historical experience is found in the British breast litigation, the current status of which is presented in this article. Furthermore, morbidity after radiotherapy is strongly influenced by concomitant surgery and/or chemotherapy, and this should be allowed for when designing the overall treatment. Apart from other therapeutic modalities, it has been suggested that other exogenous factors have an influence on the risk of radiotherapy-related morbidity. However, patients' age and, in the case of lymphoedema, also obesity are the only factors that have been established with some certainty. Routine adjustment of radiotherapy dose in these cases is not recommended. Two current developments may strengthen the role of radiotherapy in the treatment of breast cancer. Sentinel node biopsy may allow nodal staging without major surgical excision of axillary nodes and this opens the possibility for a more optimal combination of radiotherapy and surgery in the management of the axilla. With more cancers now being detected by systematic screening programmes, this will also increase the possibilities for conservative management, which in most cases involves radiotherapy. In conclusion, the improved understanding of the clinical radiobiology of late sequelae after radiotherapy allows treatment schedules and techniques to be devised that are therapeutically effective while maintaining a minimal risk of serious, late morbidity.