[an error occurred while processing this directive]|[an error occurred while processing this directive]
新型冠状病毒病疫情期间乳腺癌患者的术后辅助放疗
房辉, 王淑莲, 李晔雄
国家癌症中心/国家肿瘤临床医学研究中心/中国医学科学院北京协和医学院肿瘤医院放疗科 100021
Strategies of adjuvant radiotherapy for patients with breast cancer in COVID-19 disease outbreak
Fang Hui, Wang Shulian, Li Yexiong
Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
Abstract:Breast cancer is the most common malignancy in women in China, and adjuvant radiotherapy is an important component of multidisciplinary treatment. The 2019 novel coronavirusdisease(COVID-19) poses a significant challenge for patients to complete radiotherapy, because of a high hospital-related transmission rate of COVID-19 and a high risk of severe events for cancer patients. In this comment, we propose three major strategies for adjuvant radiotherapy in this COVID-19 outbreak:omission of radiotherapy, postponing of radiotherapy, and hypofractionated radiotherapy.
Fang Hui,Wang Shulian,Li Yexiong. Strategies of adjuvant radiotherapy for patients with breast cancer in COVID-19 disease outbreak[J]. Chinese Journal of Radiation Oncology, 2020, 29(5): 321-323.
[1] Wang DW, Hu B, Hu C, et al. Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus-Infected Pneumonia in Wuhan, China[J]. JAMA,2020,(published onlineFeb 7). DOI:10.1001/jama.2020.1585.
[2] Liang WH, Guan WJ, Chen RC, et al. Cancer patients in SARS-CoV-2 infection:a nationwide analysis in China[J]. Lancet Oncol,2020,(published onlineFeb 14). DOI:10.1016/S1470-2045(20)30096-6.
[3] Hughes KS, Schnaper LA, Bellon JR, et al. Lumpectomy plus tamoxifen with or without irradiation in women age 70 years or older with early breast cancer:long-term follow-up of CALGB 9343[J]. Jclin oncol,2013,31(19):2382-2387. DOI:10.1200/JCO.2012.45.2615.
[4] Kunkler IH, Williams LJ, Jack WJ, et al. Breast-conserving surgery with or without irradiation in women aged 65 years or older with early breast cancer (PRIMEⅡ):a randomised controlled trial[J]. Lancet Oncol,2015,16(3):266-273. DOI:10.1016/S1470-2045(14)71221-5.
[5] McCormick B, Winter K, Hudis C, et al. RTOG 9804:a prospective randomized trial for good-risk ductal carcinoma in situ comparing radiotherapy with observation[J]. J Clin Oncol,2015,33(7):709-715. DOI:10.1200/JCO.2014.57.9029.
[6] Muhsen S, Moo TA, Patil S, et al. Most Breast Cancer Patients with T1-2 Tumors and One to Three Positive Lymph Nodes Do Not Need Postmastectomy Radiotherapy[J]. Ann Surg Oncol,2018,25(7):1912-1920. DOI:10.1245/s10434-018-6422-9.
[7] Hershman DL, Wang X, McBride R, et al. Delay in initiating adjuvant radiotherapy following breast conservation surgery and its impact on survival[J]. Int J Radiat Oncol Biol Phys,2006,65(5):1353-1360. DOI:10.1016/j.ijrobp.2006.03.048.
[8] Shurell E, Olcese C, Patil S, et al. Delay in radiotherapy is associated with an increased risk of disease recurrence in women with ductal carcinoma in situ[J]. Cancer,2018,124(1):46-54. DOI:10.1002/cncr.30972.
[9] Olivotto IA, Lesperance ml, Truong PT, et al. Intervals longer than 20 weeks from breast-conserving surgery to radiation therapy are associated with inferior outcome for women with early-stage breast cancer who are not receiving chemotherapy[J]. J Clin Oncol,2009,27(1):16-23. DOI:10.1200/JCO.2008.18.1891.
[10] van Maaren MC, Bretveld RW, Jobsen JJ, et al. The influence of timing of radiation therapy following breast-conserving surgery on 10-year disease-free survival[J]. Br J Cancer,2017,117(2):179-188. DOI:10.1038/bjc.2017.159.
[11] Coles CE, Griffin CL, Kirby AM, et al. Partial-breast radiotherapy after breast conservation surgery for patients with early breast cancer (UK IMPORT LOW trial):5-year results from a multicentre, randomised, controlled, phase 3, non-inferiority trial[J]. Lancet,2017,390(10099):1048-1060. DOI:10.1016/S0140-6736(17)31145-5.
[12] Smith BD, Bellon JR, Blitzblau R, et al. Radiation therapy for the whole breast:Executive summary of an American Society for Radiation Oncology (ASTRO) evidence-based guideline[J]. PractRadiatoncol,2018,8(3):145-152. DOI:10.1016/j.prro.2018.01.012.
[13] Wang SL, Li YX. Moderately hypofractionated breast radiation therapy:is more evidence needed?-Authors′ reply[J]. Lancet Oncol,2019,20(5):e227. DOI:10.1016/S1470-2045(19)30233-5.
[14] Marta GN, Poortmans P. Moderately hypofractionated breast radiation therapy:is more evidence needed?[J]. Lancet Oncol,2019,20(5):e226. DOI:10.1016/S1470-2045(19)30078-6.
[15] Wang SL, Fang H, Song YW, et al. Hypofractionated versus conventional fractionated postmastectomy radiotherapy for patients with high-risk breast cancer:a randomised, non-inferiority, open-label, phase 3 trial[J]. Lancet Oncol,2019,20(3):352-360. DOI:10.1016/S1470-2045(18)30813-1.