PDF(Pubmed)
Abstract：
The role of postmastectomy radiotherapy and regional nodal irradiation after radical mastectomy is defined in high-risk patients with locally advanced tumors, positive margins, and unfavorable biology. The benefit of postmastectomy radiotherapy in intermediate-risk patients (T3N0 tumors) remains a matter of controversy. It has been demonstrated that radiotherapy after breast-conserving surgery lowers the locoregional recurrence rate compared with surgery alone and improves the overall survival rate. In patients with four or more positive lymph nodes or extracapsular extension, regional lymph node irradiation is indicated regardless of the surgery type (breast-conserving surgery or mastectomy). Despite the consensus that patients with more than three positive lymph nodes should be treated with radiotherapy, there is controversy regarding the recommendations for patients with one to three involved lymph nodes. In patients with N0 disease with negative findings on axillary surgery, there is a trend to administer regional lymph node irradiation in patients with a high risk of recurrence. In patients treated with neoadjuvant systemic therapy and mastectomy, adjuvant radiotherapy should be administered in cases of clinical stage III and/or ≥ypN1. In patients treated with neoadjuvant systemic therapy and breast-conserving surgery, postoperative radiotherapy is indicated irrespective of pathological response.
摘要：
在局部晚期肿瘤的高危患者中，确定了乳腺癌根治术后放疗和区域淋巴结照射的作用。正利润率，不利的生物学。中危患者（T3N0肿瘤）的乳房切除术后放疗的益处仍然存在争议。已经证明，与单独手术相比，保乳手术后的放疗降低了局部复发率，并提高了总体生存率。在有四个或更多淋巴结阳性或包膜外延伸的患者中，无论手术类型(保乳手术或乳房切除术)如何,均需进行区域淋巴结照射.尽管有三个以上淋巴结阳性的患者应接受放射治疗的共识，对于1~3个淋巴结受累患者的建议存在争议.在N0疾病患者中，腋窝手术检查结果为阴性，对于复发风险高的患者，有进行区域淋巴结照射的趋势。在接受新辅助全身治疗和乳房切除术的患者中，在临床III期和/或≥ypN1的情况下，应进行辅助放疗。在接受新辅助系统治疗和保乳手术的患者中，术后放疗的指征与病理反应无关。
