早期乳腺癌腋窝淋巴结放疗原则  

Principles of axillary radiotherapy in early breast cancer

作　　者：郑思悦 陈佳艺[1] ZHENG Si-yue;CHEN Jia-yi(Department of Radiation Oncology,Ruijin Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200025,China)

机构地区：[1]上海交通大学医学院附属瑞金医院放射治疗科,上海200025

出　　处：《中国实用外科杂志》2021年第11期1234-1238,共5页Chinese Journal of Practical Surgery

基　　金：国家重点研发计划(No.2016YFC0105409);国家自然科学基金(No.81673102,No.81602791,No.81702601,No.81803164,No.81972963);上海市科学技术委员会“科技创新行动计划”(No.19411950900,No.19411950901);上海交通大学“医学转化交叉基金”(No.ZH2018QNA54);上海市促进市级医院临床技能与临床创新能力三年行动计划(No.SHDC2020CR2052B,No.SHDC2020CR4070);上海市综合医院中西医结合专项建设(No.ZHYY-ZXYJHZ X-2-201913)。

摘　　要：早期乳腺癌病人腋窝淋巴结处理的原则是在有效控制疾病的基础上追求精准与安全。因此,以腋窝放疗替代手术成为近年来的关注焦点。在未行新辅助治疗的人群中,腋窝淋巴结初诊阴性或保乳术后前哨淋巴结(SLN)微转移的病人无须追加腋窝淋巴结清扫(ALND)或完整的腋窝照射;保乳术后SLN 1~2枚宏转移可豁免ALND并行全乳或高切线野照射,SLN转移数目>2枚或SLN外淋巴结转移风险较高者,豁免ALND后需补充腋窝放疗;乳房切除术后SLN阳性病人中目前证据不足,如未行ALND可考虑补充腋窝放疗;在接受了新辅助全身治疗的病人中,如SLN转阴可豁免ALND并补充腋窝放疗,如SLN未转阴目前依然推荐行ALND。The principle of axillary management of early breast cancer patients is to pursue precision and safety on the basis of effective disease control.Therefore,replacing axillary lymph node dissection(ALND)with axillary radiotherapy has become the focus in recent years.For patients who did not receive neoadjuvant treatment,patients with negative axillary lymph nodes at first diagnosis or with sentinel lymph node(SLN)micrometastases after breast-conserving surgery do not need ALND or axillary irradiation;patients with one or two SLN metastases after breast-conserving surgery need whole breast or high tangential field irradiation without ALND;patients with more than 2 SLN metastases or a higher risk of ALN metastases,axillary radiotherapy is required after exemption of ALND;currently there is insufficient evidence for SLN-positive patients after mastectomy without ALND,so axillary radiotherapy can be considered.Among patients who received neoadjuvant therapy,ALND can be replaced with axillary radiotherapy if the SLNs turn negative,but is still recommended if the SLNs remain positive.

关 键 词：早期乳腺癌 前哨淋巴结 腋窝淋巴结 放疗 

分 类 号：R6[医药卫生—外科学]