早期乳腺癌保乳手术后超短分割放疗
术后放疗已经成为大多数早期乳腺癌保乳手术患者的标准治疗方法。第一代术后放疗方案需要每天进行全乳放疗5～7周，虽然有效，但是延长了患者的疗程，降低了依从性和生活质量。短分割全乳放疗已成为治疗标准和第二代放疗方案之一，不过仍然需要3～4周。同时，局部乳房放疗还被探索作为一种在更短时间（1～3周）内完成放疗的技术。
2021年1月13日，美国肿瘤外科学会和美国乳腺外科医师学会《肿瘤外科学报》在线发表克利夫兰医学中心、迈阿密癌症治疗中心、纽约纪念医院斯隆凯特林癌症中心、弗吉尼亚联邦大学、布朗大学阿尔伯特医学院、密歇根州法明顿山创世关怀肿瘤医院的综述，对超短分割计划作为早期乳腺癌简化治疗策略的一部分进行了回顾。
现有7项临床研究证实了较短放疗方案与标准全乳放疗相比效果相似。为了进一步缩短治疗时间，近年来出现超短全乳放疗和局部乳房放疗方案，作为第三代乳房放疗方案，可在≤5天内完成治疗。
关于全乳放疗，FAST-Forward研究对1周内完成5次全乳放疗与3周全乳放疗进行了比较，最新数据表明，5年临床结局相似，且毒性相差不大。
关于局部乳房放疗，2周内完成5次放疗研究公开数据也表明10年结局相似，并且通过长期随访发现毒性减少。
该综述还对其他正在进行的研究进行回顾，探讨了更短时间内完成1～5次术后放疗方案，包括单次局部乳房放疗或全乳放疗。
相关链接
Ann Surg Oncol. 2021 Jan 13. Online ahead of print.
Ultra-Short Fraction Schedules as Part of De-intensification Strategies for Early-Stage Breast Cancer.
Chirag Shah, Martin Keisch, Atif Khan, Douglas Arthur, David Wazer, Frank Vicini.
Cleveland Clinic, Cleveland, OH, USA; Cancer HealthCare Associates, Miami, FL, USA; Memorial Sloan Kettering Cancer Center, New York, NY, USA; Virginia Commonwealth University, Richmond, VA, USA; Alpert Medical School of Brown University, Providence, RI, USA; GenesisCare, Farmington Hills, MI, USA.
Adjuvant radiation therapy (RT) following breast-conserving surgery (BCS) represents a standard approach for most patients treated with breast-conserving therapy (BCT) for early-stage breast cancer. The first-generation of adjuvant RT schedules delivered daily treatment to the whole breast over 5-7 weeks. Although efficacious, this presented patients with a protracted course of treatment, reducing compliance and quality of life. While hypofractionated whole-breast irradiation (WBI) has become the standard, and part of the second-generation of RT regimens, it still requires 3-4 weeks. Concurrently, partial-breast irradiation (PBI) has also been explored as a technique to complete RT in a much shorter time period (1-3 weeks). There are now seven trials confirming the efficacy of this shorter treatment approach compared with standard WBI. In an effort to further reduce treatment duration, ultra-short WBI and PBI regimens have recently emerged as the third-generation of breast radiation schedules, allowing for the completion of treatment in 5 days or less. With respect to WBI, recent data from the FAST-Forward trial (which evaluated five fractions of WBI delivered in 1 week) demonstrated no difference in clinical outcomes at 5 years, with limited difference in toxicity, compared with hypofractionated 3-week WBI. Regarding PBI, published data on five-fraction regimens delivered in 2 weeks have also demonstrated comparable outcomes at 10 years, with reduced toxicities with long-term follow-up. This report will review additional ongoing studies evaluating even shorter courses of adjuvant RT treatment (one to five fractions), including single-fraction PBI or WBI.
DOI: 10.1245/s10434-020-09526-y