術中放射治療於早期乳癌病患的應用與現況

10.6666/ClinMed.2017.79.4.038

蔡宜芳；林燕淑；曾令民

乳癌(breast cancer) ； 乳房保留手術(breast conserving surgery) ； 放射治療(radiotherapy) ； 術中放射治療(intraoperative radiotherapy, IORT)

臨床醫學月刊

79卷4期（2017 / 04 / 28）

204 - 210

繁體中文

選擇以乳房保留手術為術式的早期乳癌病患，需配合放射治療，降低患側局部復發的機會。術中放射治療提供乳房保留手術病患除了術後全乳房照射的另一項選擇，但目前適應症及其風險都有需審慎考量的必要，現有的臨床試驗證據尚待時間驗證。本文希望藉由解讀現有文獻以較嚴謹的態度看待新技術。

1. (2016).National Comprehensive Cancer Network Guidelines 2016.
2. Darby, S,McGale, P,Correa, C(2011).Effect of radiotherapy after breastconserving surgery on 10-year s recurrence and 15-year breast cancer death: meta- analysis of individual patient data for 10,801 women in 17 randomised trials.Early Breast Cancer Trialists Collaborative Group(EBCTCG) Lancet,378,1707-1716.
3. Darby, SC,Ewertz, M,McGale, P(2013).Risk of ischemic heart disease in women after radiotherapy for breast cancer.N Engl J Med,368,987-998.
4. Fisher, B,Anderson, S,Bryant, J(2002).Twenty-year follow- up of a randomized trial comparing total mastectomy, lumpectomy, and lumpectomy plus irradiation for the treatment of invasive breast cancer.N Engl J Med,347,1233-1241.
5. Fisher, B,Bauer, M,Margolese, R(1985).Five-year results of a randomized clinical trial comparing total mastectomy and segmental mastectomy with or without radiation in the treatment of breast cancer.N Engl J Med,312,665-673.
6. Imamura, H,Haga, S,Shimizu, T(2000).Relationship between the morphological and biological characteristics of intraductal components accompanying invasive ductal breast carcinoma and patient age.Breast Cancer Res Treat,62,177-184.
7. Ohtake, T,Abe, R,Kimi jima, I(1995).Intraductal extension of primary invasive breast carcinoma treated by breast-conservative.Surgery Cancer,76,32-45.
8. Shaitelman, S,Lin, H,Shen, Y(2013).Utilization of accelerated partialbreast irradiation(APBI)and guideline concordance: Analysis of the National Cancer Database.J Clin Oncol,31
9. Smith, BD,Arthur, DW,Buchholz, TA(2009).Accelerated partial breast irradiation consensus statement from the American Society for Radiation Oncology(ASTRO).Int J Radiat Oncol Biol Phys,74,987-1001.
10. Vaidya, JS,Joseph, DJ,Tobias, JS(2010).Targeted intraoperative radiotherapy versus whole breast radiotherapy for breast cancer(TARGIT-A trial): an international, prospective, randomised, non-inferiority phase 3 trial.Lancet,376,91-102.
11. Vaidya, JS,Wenz, F,Bulsara, M(2014).Risk- adapted targeted intraoperative radiotherapy versus whole-breast radiotherapy for breast cancer: 5-year results for local control and overall survival from the TARGIT-A randomised trial.Lancet,383,603-613.
12. Veronesi, U,Marubini, E,Mariani, L(2001).Radiotherapy after breast-conserving surgery in small breast carcinoma: longterm results of a randomized trial.Ann Oncol,12,997-1003.
13. Veronesi, U,Orecchia, R,Maisonneuve, P(2013).Intraoperative radiotherapy versus external radiotherapy for early breast cancer(ELIOT): a randomised controlled equivalence trial.Lancet Oncol,14,1269-1277.
14. Vicini, F,Winter, K,Wong, J(2010).Initial efficacy results of RTOG 0319: threedimensional conformal radiation therapy(3D-CRT)confined to the region of the lumpectomy cavity for stage I/II breast carcinoma.Int J Radiat Oncol Biol Phys,77,1120-1127.
15. Vicini, FA,Kestin, LL,Goldstein, NS(2004).De¿ning the clinical target volume for patients with early-stage breast cancer treated with lumpectomy and accelerated partial breast irradiation: A pathologic analysis.Int J Radiat Oncol Biol Phys,60,722-730.
16. Whelan, T,MacKenzie, R,Julian, J(2002).Randomized trial of breast irradiation schedules after lumpectomy for women with lymph node-negative breast cancer.J Natl Cancer Inst,94,1143-1450.