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Как цитировать
Аннотация
Введение. Облучение регионарных лимфатических узлов при раке молочной железы сопряжено с высоким риском нежелательных явлений, таких как лимфедема, и «перелечивание» может повлечь за собой значительные последствия без улучшения онкологических результатов. Предварительные пятилетние данные недавнего проспективного исследования указывают на безопасность деэскалации лучевой терапии в отношении выживаемости, однако другие исследования менее утешительны и международный консенсус по данному вопросу не достигнут.
Цель. Обозначить когорту больных, в которой деэскалация лучевой терапии при раке молочной железы после неоадъювантной полихимиотерапии и полного патоморфологического ответа в регионарных лимфатических узлах может быть безопасной с точки зрения онкологических результатов.
Материалы и методы. Нами проанализированы ретроспективные и проспективные исследования, посвященные сравнению групп пациентов, получающих и не получающих облучение регионарных зон после неоадъювантной химиотерапии с полным патоморфологическим ответом в лимфатических узлах. Для поиска публикаций использована база данных PubMed и следующие термины: breast cancer, regional lymph node irradiation, pathological complete response, radiotherapy deescalation.
Результаты. В обзор включены 28 публикаций. Преимущество в отношении общей выживаемости и/или локорегионарного контроля в большинстве исследований получено только в случае наличия дополнительных факторов риска: распространенная клиническая стадия, отрицательный рецепторный статус. В одном исследовании преимущество для локорегионарного контроля получено у пациентов с люминальным подтипом, а также в одной публикации говорится о достоверном улучшении общей выживаемости от облучения регионарных зон после полного патоморфологического ответа в них при отсутствии полного ответа в ткани первичной опухоли. По данным предварительных результатов проспективного исследования NSABP B-51, пациентки с исходно ограниченным поражением лимфатических узлов с последующим полным патоморфологическом ответом в них не выигрывают от проведения лучевой терапии.
Выводы. Учитывая отсутствие окончательных результатов проспективного исследования NSABP B-51, противоречивость результатов ретроспективных исследований, представляется разумным проведение лучевой терапии на основании исходной клинической стадии в соответствии с действующими клиническими рекомендациями.
Библиографические ссылки
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