Tumors of female reproductive systemTumors of female reproductive systemОпухоли женской репродуктивной системы1994-40981999-8627Publishing House ABV Press22510.17650/1994-4098-2010-0-2-26-30MAMMOLOGY. TREATMENTМАММОЛОГИЯ. ЛЕЧЕНИЕUse of hypofractionated radiotherapy regimens after organ-sparing surgery for Stages I–IIA breast cancersПрименение гипофракционированных режимов лучевой терапии после органосохраняющих операций по поводу рака молочной железы I–IIA стадийEfimkinaYu. V.ЕфимкинаЮ. В.
Russian Federation
0152@mail.ruGladilinaI. A.ГладилинаИ. А.
Russian Federation
NechushkinM. I.НечушкинМ. И.
Russian Federation
Department of Radiosurgery, N.N. Blokhin Russian Cancer Research Center, Russian Academy of Medical Sciences, MoscowОтделение радиохирургии ГУ РОНЦ им. Н.Н. Блохина РАМН, Москва270520102263027082014270820142010https://ojrs.abvpress.ru/ojrs/article/view/225

There have been recent reports on the expediency of applying postoperative hypofractionated accelerated radiotherapy (RT) regimens in patients who have undergone breast-sparing surgery. The concept of accelerated hypofractionation (AH) includes daily high-dose radiation for a shorter total period of time. In most radiologists’ opinion, the AH RT regimen may be as effective as more conventional treatments that use lower daily radiation doses for a longer period. The appeal of this method is that shorter treatment provides more convenience for patients. By taking into account the fact that the α/β ratio for intact breast tissues is about 3.5 Gy, larger fraction RT regi- mens are likely to be more effective, which will reduce the frequency of recurrences as compared with conventional therapy approaches without increasing the incidence of postradiation intact tissue damage.

В последние годы появились сообщения о целесообразности применения гипофракционированных ускоренных режимов послеоперационной лучевой терапии (ЛТ) у больных, перенесших органосохраняющие операции на молочной железе. Понятие концепции ускоренного гипофракционирования (УГ) включает в себя проведение облучения в больших суточных дозах за более короткий общий период времени. По мнению большинства радиологов, режим УГ ЛТ может быть столь же эффективным, как и более стандартные способы лечения, при которых применяют меньшие суточные дозы, подводимые за более длительный период времени. Привлекательность этого метода заключается в том, что сокращение длительности лечения приводит к повышению удобства для пациенток. С учетом того что соотношение α/β для нормальных тканей молочной железы составляет примерно 3,5 Гр, вероятно, более эффективными будут режимы ЛТ с большей фракцией, что позволит снизить частоту развития рецидивов, по сравнению со стандартными подходами к терапии без увеличения частоты возникновения постлучевых повреждений нормальных тканей.

breast cancerradiotherapyhypofractionationрак молочной железылучевая терапиягипофракционирование1. Давыдов М.И., Аксель Е.М. Статистика злокачественных новообразований в России и странах СНГ в 2004 г. Вестн РОНЦ им. Н.Н. Блохина РАМН 2008; 15(2):10–2, 24–6, 57–8, 63–4.Давыдов М.И., Аксель Е.М. Статистика злокачественных новообразований в России и странах СНГ в 2004 г. Вестн РОНЦ им. Н.Н. Блохина РАМН 2008; 15(2):10–2, 24–6, 57–8, 63–4.2. Давыдов М.И., Летягин В.П. Практическая маммология. М., 2007; с. 106–15.Давыдов М.И., Летягин В.П. Практическая маммология. М., 2007; с. 106–15.3. Silva O.E., Zurrida S. Breast Cancer: a practical guide. 3rd ed. NY: Elsevier, 2005; p. 171–84.Silva O.E., Zurrida S. Breast Cancer: a practical guide. 3rd ed. NY: Elsevier, 2005; p. 171–84.4. Truong P.T., Jones S.O., Kader H.A., Wai E.S. Patients with T1 to T2 breast cancer with one to three positive nodes have higher local and regional recurrence risks compared with node-negative patients after breast-conserving surgery and whole-breast radiotherapy. Int J Radiat Oncol Biol Phys 2009;73(2):357–64 .Truong P.T., Jones S.O., Kader H.A., Wai E.S. Patients with T1 to T2 breast cancer with one to three positive nodes have higher local and regional recurrence risks compared with node-negative patients after breast-conserving surgery and whole-breast radiotherapy. Int J Radiat Oncol Biol Phys 2009;73(2):357–64 .5. Goldhirsch A., Glick J.H., Gelber R.D. et al. Meeting highlights: international expert consensus on the primary therapy of early breast cancer 2005; ESO – Moscow breast cancer forum, 2005; p. 3–17.Goldhirsch A., Glick J.H., Gelber R.D. et al. Meeting highlights: international expert consensus on the primary therapy of early breast cancer 2005; ESO – Moscow breast cancer forum, 2005; p. 3–17.6. Hannan L., Spierer M., Skinner W. et al. Hypofractionated whole breast radiation therapy for large-breasted patients. Proceedings of the 51st Annual ASTRO Meeting No2095. Jnt J Radiat Oncol Biol Phys 2009; 75(3 Suppl):223.Hannan L., Spierer M., Skinner W. et al. Hypofractionated whole breast radiation therapy for large-breasted patients. Proceedings of the 51st Annual ASTRO Meeting No2095. Jnt J Radiat Oncol Biol Phys 2009; 75(3 Suppl):223.7. Чехонадский В.Н. Радиационно- биофизические основы сочетанного облучения онкологических больных. Автореф. дис. ... д-р биол. наук. М., 1999.Чехонадский В.Н. Радиационно- биофизические основы сочетанного облучения онкологических больных. Автореф. дис. ... д-р биол. наук. М., 1999.8. Yarnold J., Owen R., Ashton A. et al. Fractionation sensitivity of change in breast appearance after radiotherapy for early breast cancer: results of a phase III randomised trial. Abstracts – Poster Session I 24th Annual San Antonio Breast Cancer Symposium, 2001; p. 154.Yarnold J., Owen R., Ashton A. et al. Fractionation sensitivity of change in breast appearance after radiotherapy for early breast cancer: results of a phase III randomised trial. Abstracts – Poster Session I 24th Annual San Antonio Breast Cancer Symposium, 2001; p. 154.9. Yarnold J., Ashton A., Bliss J. et al. Fractionation sensitivity and dose response of late adverse effects in the breast after radiotherapy for early breast cancer: long- term results of a randomized trial. Radiother Oncol 2005;75(1):9–17.Yarnold J., Ashton A., Bliss J. et al. Fractionation sensitivity and dose response of late adverse effects in the breast after radiotherapy for early breast cancer: long- term results of a randomized trial. Radiother Oncol 2005;75(1):9–17.10. Whelan T., Clark R., Roberts R. et al. Ipsilateral breast tumor recurrence postlumpectomy is predictive of subsequent mortality. Results from a randomized trial. Int J Radiat Oncol Biol Phys 1994;30:11–6.Whelan T., Clark R., Roberts R. et al. Ipsilateral breast tumor recurrence postlumpectomy is predictive of subsequent mortality. Results from a randomized trial. Int J Radiat Oncol Biol Phys 1994;30:11–6.11. Baillet F., Housset M., Maylin C. et al. The use of a specific hypofractionated radiation therapy regimen versus classical fractionation in the treatment of breast cancer: A randomized study of 230 patients. Int J Radiat Oncol Biol Phys 1999;19:1131–3.Baillet F., Housset M., Maylin C. et al. The use of a specific hypofractionated radiation therapy regimen versus classical fractionation in the treatment of breast cancer: A randomized study of 230 patients. Int J Radiat Oncol Biol Phys 1999;19:1131–3.12. Chadha M., Woode R., Sillanpaa J. et al. Three-week accelerated radiation therapy (ART) schedule with a concomitan2t in-field boost as treatment for early stage breast cancer. Int J Radiat Oncol Biol Phys 2007;69:137.Chadha M., Woode R., Sillanpaa J. et al. Three-week accelerated radiation therapy (ART) schedule with a concomitan2t in-field boost as treatment for early stage breast cancer. Int J Radiat Oncol Biol Phys 2007;69:137.13. Freedman G.M., Anderson P., Litwin S. et al. Four-week course of radiation for breast cancer using hypo fractionated intensity modulated radiation therapy with an incorporated boost. Proceedings of the 51st Annual ASTRO Meeting No163. Int J Radiat Oncol Biol Phys 2009;75(3 Suppl):77.Freedman G.M., Anderson P., Litwin S. et al. Four-week course of radiation for breast cancer using hypo fractionated intensity modulated radiation therapy with an incorporated boost. Proceedings of the 51st Annual ASTRO Meeting No163. Int J Radiat Oncol Biol Phys 2009;75(3 Suppl):77.14. Saha S., Ghosh Dastidar A., Ghanem M. et al. Patterns of recurrence and nodal staging in rectal cancer patients undergoing sentinel lymph node mapping compared to conventional surgery. Int J Radiat Oncol Biol Phys 2009;75(3 Suppl):166–7.Saha S., Ghosh Dastidar A., Ghanem M. et al. Patterns of recurrence and nodal staging in rectal cancer patients undergoing sentinel lymph node mapping compared to conventional surgery. Int J Radiat Oncol Biol Phys 2009;75(3 Suppl):166–7.15. Karasawa K., Ozawa S., Yamaguchi S. Int Proceedings of the 51st Annual ASTRO Meeting N2011. Int J Radiat Oncol Biol Phys 2009;75(3 Suppl):185.Karasawa K., Ozawa S., Yamaguchi S. Int Proceedings of the 51st Annual ASTRO Meeting N2011. Int J Radiat Oncol Biol Phys 2009;75(3 Suppl):185.