低负荷前哨淋巴结阳性早期乳腺癌患者腋窝处理策略

doi:10.3760/cma.j.issn.1004-4221.2018.06.016

摘要
图/表
参考文献()
相关文章 (3)
点击分布统计
下载分布统计

全文: PDF (0 KB) HTML (1 KB)
输出: BibTeX | EndNote (RIS) 背景资料

摘要

前哨淋巴结阳性患者的常规处理是进一步行腋窝淋巴结清扫,但腋窝淋巴结清扫会带来血清肿、上肢功能障碍、水肿等并发症。Z0011、IBCSG 23-01和AMAROS的Ⅲ期随机对照临床研究探索均为在临床N0期患者中安全减免前哨淋巴结活检阳性后的腋窝淋巴结清扫,为这部分患者的腋窝处理提供了新选择,但也给辅助放疗决策带来了新问题。本文将主要基于上述三项临床研究和腋窝淋巴结转移复发风险相关最新文献,针对包括手术和辅助放疗在内的低负荷前哨淋巴结阳性患者腋窝处理策略进行综述。

	服务

	把本文推荐给朋友
	加入我的书架
	加入引用管理器
	E-mail Alert
	RSS
	作者相关文章
	曹璐
	陈佳艺

关键词 ：早期乳腺肿瘤/放射疗法, 前哨淋巴结阳性, 腋窝淋巴结

Abstract：

For patients with positive sentinel lymph nodes, axillary lymph node dissection (ALND) is the conventional treatment. However, ALND can cause seroma, the upper limb dysfunction, edema and alternative complications. Z0011, IBCSG 23-01 and AMAROS phase Ⅲ randomized controlled clinical trials recommend ALND after sentinel lymph node biopsy in N0 patients, which provides a novel option for axillary lymph node treatment, but also brings new challenges to the decision of adjuvant radiotherapy. In this paper, based upon these three clinical trials and latest literatures related to the risk of axillary lymph node metastasis and recurrence, the therapeutic strategies including surgery and adjuvant radiotherapy for patients with positive sentinel lymph nodes are reviewed and summarized.

Key words： Early breast neoplasm/radiotherapy Positive sentinel lymph node Axillary lymph node

收稿日期: 2017-07-28

基金资助:

国家自然科学基金资助(81172504、81673102、81602791);国家重点研发计划资助(2016YFC0105409);上海市卫生和计划生育委员会科研课题青年项目基金资助(20164Y0066)

通讯作者: 陈佳艺,Chen Jiayi,Email:chenjiayi0188@aliyun.com

引用本文:

曹璐,陈佳艺. 低负荷前哨淋巴结阳性早期乳腺癌患者腋窝处理策略[J]. 中华放射肿瘤学杂志, 2018, 27(6): 612-615.

Cao Lu,Chen Jiayi. Therapeutic strategies of axillary treatment for early breast cancer patients with positive sentinel lymph nodes[J]. Chinese Journal of Radiation Oncology, 2018, 27(6): 612-615.

链接本文:

http://journal12.magtechjournal.com/Jweb_fszlx/CN/10.3760/cma.j.issn.1004-4221.2018.06.016 或 http://journal12.magtechjournal.com/Jweb_fszlx/CN/Y2018/V27/I6/612

[1] Perou CM,Sørlie T,Eisen MB,et al. Molecular portraits of human breast tumours[J].Nature,2000,406(6797):747-752.DOI:10.1038/35021093.
[2] Goldhirsch A,Wood WC,Coates AS,et al. Strategies for subtypes—dealing with the diversity of breast cancer:highlights of the St Gallen International Expert Consensus on the Primary Therapy of Early Breast Cancer 2011[J].Ann Oncol,2011,22(8):1736-1747.DOI:10.1093/annonc/mdr304.
[3] Goldhirsch A,Winer EP,Coates AS,et al. Personalizing the treatment of women with early breast cancer:highlights of the St Gallen International Expert Consensus on the Primary Therapy of Early Breast Cancer 2013[J].Ann Oncol,2013,24(9):2206-2223.DOI:10.1093/annonc/mdt303.
[4] Lyman GH,Giuliano AE,Somerfield MR,et al. American society of clinical oncology guideline recommendations for sentinel lymph node biopsy in early-stage breast cancer[J].J Clin Oncol,2005,23(30):7703-7020.DOI:10.1200/JCO.2005.08.001.
[5] Rao R,Euhus D,Mayo HG,et al. Axillary node interventions in breast cancer:a systematic review[J].JAMA,2013,310(13):1385-1394.DOI:10.1001/jama.2013.277804.
[6] Yeoh EK,Denham JW,Davies SA,et al. Primary breast cancer complications of axillary management[J].Acta Radiol Oncol,1986,25(2):105-108.DOI:10.3109/02841868609136386.
[7] Lotze MT,Duncan MA,Gerber LH,et al. Early versus delayed shoulder motion following axillary dissection:a randomized prospective study[J].Ann Surg,1981,193(3):288-295.DOI:10.1097/00000658-198103000-00007.
[8] Ivens D,Hoe AL,Podd TJ,et al. Assessment of morbidity from complete axillary dissection[J].Br J Cancer,1992,66(1):136-138.DOI:10.1038/bjc.1992.230.
[9] Swedish Organised Service Screening Evaluation Group. Effect of mammographic service screening on stage at presentation of breast cancers in Sweden[J].Cancer,2007,109(11):2205-2212.DOI:10.1002/cncr.22671.
[10] Giuliano AE,Hunt KK,Ballman KV,et al. Axillary dissection vs. no axillary dissection in women with invasive breast cancer and sentinel node metastasis:a randomized clinical trial[J].JAMA,2011,305(6):569-575.DOI:10.1001/jama.2011.90.
[11] Galimberti V,Cole BF,Zurrida S,et al. Axillary dissection versus no axillary dissection in patients with sentinel-node micrometastases (IBCSG 23-01):a phase 3 randomised controlled trial[J].Lancet Oncol,2013,14(4):297-305.DOI:10.1016/S1470-2045(13)70035-4.
[12] Donker M,Van Tienhoven G,Straver ME,et al. Radiotherapy or surgery of the axilla after a positive sentinel node in breast cancer (EORTC 10981-22023 AMAROS):a randomised,multicentre,open-label,phase 3 non-inferiority trial[J].Lancet Oncol,2014,15(12):1303-1310.DOI:10.1016/S1470-2045(14)70460-7.
[13] Gradishar WJ,Anderson BO,Balassanian R,et al. NCCN guidelines insights:breast cancer,version 1.2017[J].J Natl Compr Cancer Netw,2017,15(4):433-451.DOI:10.6004/jnccn.2017.0044.
[14] Gnant M,Harbeck N,Thomssen C.St. Gallen/Vienna 2017:a brief summary of the consensus discussion about escalation and De-escalation of primary breast cancer treatment[J].Breast Care,2017,12(2):102-107.
[15] Giuliano AE,Ballman K,McCall L,et al. Locoregional recurrence after sentinel lymph node dissection with or without axillary dissection in patients with sentinel lymph node metastases:Long-term Follow-up from the American College of Surgeons Oncology Group (Alliance) ACOSOG Z0011 randomized trial[J].Ann Surg,2016,264(3):413-420.DOI:10.1097/SLA.0000000000001863.
[16] Jagsi R,Chadha M,Moni J,et al. Radiation field design in the ACOSOG Z0011(Alliance) Trial[J].J Clin Oncol,2014,32(32):3600-3606.DOI:10.1200/JCO.2014.56.5838.
[17] Haffty BG,Hunt KK,Harris JR,et al. Positive sentinel nodes without axillary dissection:implications for the radiation oncologist[J].J Clin Oncol,2011,29(34):4479-4481.DOI:10.1200/JCO.2011.36.1667.
[18] 朱传营,蔡钢,胡伟刚,等.乳房保留术后野中野正向调强全乳房照射的腋窝淋巴结剂量学研究[J].中华放射肿瘤学杂志,2014,23(6):500-504.DOI:10.3760/cma.j.issn.1004-4221.2014.06.011.
Zhu CY,Cas G,Hu WG,et al. Radiation doses to axillary lymph nodes in patients with early breast cancer receiving field-in-field forward-planned intensity-modulated radiotherapy for whole breast irradiation after breast-conserving surgery[J].Chin J Radiat Oncol,2014,23(6):500-504.DOI:10.3760/cma.j.issn.1004-4221.2014.06.011.
[19] Reznik J,Cicchetti MG,Degaspe B,et al. Analysis of axillary coverage during tangential radiation therapy to the breast[J].Int J Radiat Oncol Biol Phys,2005,61(1):163-168.DOI:10.1016/j.ijrobp.2004.04.065.
[20] Reed DR,Lindsley SK,Mann GN,et al. Axillary lymph node dose with tangential breast irradiation[J].Int J Radiat Oncol Biol Phys,2005,61(2):358-364.DOI:10.1016/j.ijrobp.2004.06.006.
[21] Surmann K,Van Der Leer J,Branje T,et al. Elective breast radiotherapy including level I and Ⅱ lymph nodes:a planning study with the humeral head as planning risk volume[J].Radiat Oncol,2017,12:22.DOI:10.1186/s13014-016-0759-7.
[22] Van Zee KJ,Manasseh DM,Bevilacqua JL,et al. A nomogram for predicting the likelihood of additional nodal metastases in breast cancer patients with a positive sentinel node biopsy[J].Ann Surg Oncol,2003,10(10):1140-1051.DOI:10.1245/ASO.2003.03.015.
[23] Alran S,De Rycke Y,Fourchotte V,et al. Validation and limitations of use of a breast cancer nomogram predicting the likelihood of non-sentinel node involvement after positive sentinel node biopsy[J].Ann Surg Oncol,2007,14(8):2195-2201.
[24] Sasada T,Murakami S,Kataoka T,et al. Memorial Sloan-Kettering Cancer Center Nomogram to predict the risk of non-sentinel lymph node metastasis in Japanese breast cancer patients[J].Surg Today,2012,42(3):245-249.DOI:10.1007/s00595-011-0088-2.
[25] Katz A,Smith BL,Golshan M,et al. Nomogram for the prediction of having four or more involved nodes for sentinel lymph node-positive breast cancer[J].J Clin Oncol,2008,26(13):2093-2098.DOI:10.1200/JCO.2007.11.9479.
[26] Senkus E,Kyriakides S,Ohno S,et al. Primary breast cancer:ESMO Clinical Practice Guidelines for diagnosis,treatment and follow-up[J].Ann Oncol,2015,26 Suppl 5:v8-30.DOI:10.1093/annonc/mdv298.
[27] Whelan TJ,Olivotto IA,Parulekar WR,et al. Regional nodal irradiation in early-stage breast cancer[J].N Engl J Med,2015,373(4):307-316.DOI:10.1056/NEJMoa1415340.
[28] Poortmans PM,Collette S,Kirkove C,et al. Internal mammary and medial supraclavicular irradiation in breast cancer[J].N Engl J Med,2015,373(4):317-27.DOI:10.1056/NEJMoa1415369.
[29] Thorsen LB,Offersen BV,Danø H,et al. DBCG-IMN:a population-based cohort study on the effect of internal mammary node irradiation in early node-positive breast cancer[J].J Clin Oncol,2016,34(4):314-320.DOI:10.1200/JCO.2015.63.6456.