Postmastectomy Radiation Therapy: An ASTRO/ASCO/SSO Clinical Practice Guideline.

IF 3.5 3区 医学 Q2 ONCOLOGY
Rachel B Jimenez, Yara Abdou, Penny Anderson, Parul Barry, Lisa Bradfield, Julie A Bradley, Lourdes D Heras, Atif Khan, Cindy Matsen, Rachel Rabinovitch, Chantal Reyna, Kilian E Salerno, Sarah E Schellhorn, Deborah Schofield, Kekoa Taparra, Iman Washington, Jean L Wright, Youssef H Zeidan, Richard C Zellars, Kathleen C Horst
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引用次数: 0

Abstract

Purpose: This guideline provides evidence-based recommendations on the use of postmastectomy radiation therapy (PMRT) in the treatment of breast cancer. PMRT refers to the treatment of the chest wall and ipsilateral regional nodes, including at-risk axillary, supra/infraclavicular, and internal mammary nodes. Updated recommendations detail indications for PMRT in the upfront surgical setting and after neoadjuvant systemic therapy, and provide guidance on appropriate target volumes, dosing, and treatment techniques.

Methods: The American Society for Radiation Oncology, American Society of Clinical Oncology, and the Society of Surgical Oncology convened a multidisciplinary task force to address 4 key questions focused on radiation therapy (RT) in patients with breast cancer who undergo mastectomy including (1) indications for PMRT after upfront surgery, (2) indications for PMRT after neoadjuvant systemic therapy followed by surgery, (3) appropriate PMRT treatment volumes and dose-fractionation regimens, and (4) treatment techniques. Recommendations were based on a systematic literature review and created using a predefined consensus-building methodology and system for quality of evidence grading and strength of recommendation.

Results: After upfront mastectomy, PMRT is indicated for most patients with node-positive breast cancer and select patients with node-negative disease. PMRT is also recommended after neoadjuvant systemic therapy, both for patients presenting with locally advanced disease and for those with residual nodal disease at the time of surgery. PMRT is conditionally recommended for patients with cT1-3N1 or cT3N0 breast cancer with pathologically negative nodes after neoadjuvant systemic therapy (ypN0). When PMRT is delivered, treatment to the ipsilateral chest wall/reconstructed breast and regional lymphatics is recommended, with moderate hypofractionation preferred, but with conventional fractionation approaches acceptable in rare cases. Computed tomography-based volumetric treatment planning with 3-dimensional conformal RT is recommended, with intensity modulated RT advised when 3-dimensional conformal RT is unable to achieve treatment goals. Deep inspiration breath hold techniques are also recommended for normal tissue sparing. For patients with skin involvement, positive superficial margins, and/or lymphovascular invasion, the use of a bolus is recommended, but the routine use of tissue-equivalent bolus is not recommended.

Conclusions: These evidence-based recommendations guide clinical practice on the use of PMRT in patients with breast cancer.

乳房切除术后放射治疗:ASTRO/ASCO/SSO临床实践指南。
目的:本指南为乳腺切除术后放射治疗(PMRT)在乳腺癌治疗中的应用提供了循证建议。PMRT是指胸壁和同侧区域淋巴结的治疗,包括有危险的腋窝、锁骨上/锁骨下和乳房内部淋巴结。最新的建议详细说明了术前和新辅助全身治疗后PMRT的适应症,并提供了适当的靶体积、剂量和治疗技术的指导。方法:美国放射肿瘤学会、美国临床肿瘤学会和外科肿瘤学会召集了一个多学科工作组,以解决乳腺癌乳房切除术患者放射治疗(RT)的4个关键问题,包括(1)术前PMRT的适应症,(2)手术后新辅助全身治疗后PMRT的适应症,(3)适当的PMRT治疗量和剂量分割方案,(4)处理技术。建议是基于系统的文献综述,并使用预先确定的共识建立方法和证据质量、分级和建议力度的系统制定的。结果:乳房前期切除术后,大部分淋巴结阳性乳腺癌患者和部分淋巴结阴性乳腺癌患者适用PMRT。PMRT也被推荐用于新辅助全身治疗后,无论是局部晚期疾病患者还是手术时淋巴结残留疾病患者。对于新辅助全身治疗(ypN0)后病理阴性淋巴结的cT1-3N1或cT3N0乳腺癌患者,有条件推荐PMRT。当进行PMRT时,建议对同侧胸壁/重建乳房和局部淋巴管进行治疗,首选中度低分割,但在极少数情况下可以接受传统的分割方法。建议采用三维适形放射治疗的基于计算机断层扫描的体积治疗计划,当三维适形放射治疗无法达到治疗目标时,建议采用强度调节放射治疗。深吸气屏气技术也被推荐用于正常组织保留。对于累及皮肤、浅表边缘阳性和/或淋巴血管侵犯的患者,建议使用大剂量,但不建议常规使用组织当量大剂量。结论:这些基于证据的建议指导了乳腺癌患者使用PMRT的临床实践。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Practical Radiation Oncology
Practical Radiation Oncology Medicine-Radiology, Nuclear Medicine and Imaging
CiteScore
5.20
自引率
6.10%
发文量
177
审稿时长
34 days
期刊介绍: The overarching mission of Practical Radiation Oncology is to improve the quality of radiation oncology practice. PRO''s purpose is to document the state of current practice, providing background for those in training and continuing education for practitioners, through discussion and illustration of new techniques, evaluation of current practices, and publication of case reports. PRO strives to provide its readers content that emphasizes knowledge "with a purpose." The content of PRO includes: Original articles focusing on patient safety, quality measurement, or quality improvement initiatives Original articles focusing on imaging, contouring, target delineation, simulation, treatment planning, immobilization, organ motion, and other practical issues ASTRO guidelines, position papers, and consensus statements Essays that highlight enriching personal experiences in caring for cancer patients and their families.
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