放射線治療在乳癌的使用

Radiotherapy for Breast Cancer

黃品逸(Pin-I Huang) ； 顏上惠(Sang-Hue Yen)

《中華民國癌症醫學會雜誌》 24卷2期 (2008/04) Pp. 121-126

https://doi.org/10.6588/JCOS.2008.24.2.7

摘要

放射治療運用於乳癌的治療已經有超過百年的歷史，在乳癌的整合治療中佔有相當重要的角色。早年，放射治療在乳癌治療的主要應用是使用於乳癌的晚期治療，例如乳房切除手術後復發或是無法以手術切除的乳癌。而在現今，隨著醫學的進步，乳癌的治療有很大的改變，放射治療也變成乳癌手術後輔助性治療中相當重要的一部分，例如早期乳癌或是原位癌的病人，乳房腫瘤局部切除後，加上手術後放射線治療，可達到乳房保存的目的；或是全乳房切除手術後具有高復發風險的患者，術後放射線治療可以提高局部控制率與存活率。放射治療的方式－全乳房照射或胸壁照射－主要是依據手術的方式而定。在乳房局部切除腫瘤後，全乳房接受中等放射治療劑量的照射，可以殺死殘餘的顯微腫瘤細胞，因此大幅減少腫瘤的局部復發率，有助於增加存活率。同樣地，全乳房切除手術後的胸壁照射可以減少局部復發的風險、增加無疾病存活率、以及降低患者死於乳癌的危險。乳癌最合適的局部治療方式需要外科醫師、放射腫瘤科醫師以及內科腫瘤醫師共同努力合作。而這種多科治療團隊的合作，提供了理想的局部治療與全身系統性治療協調整合的機會。本文主要回顧介紹乳癌放射治療的適應症、放射治療技術等等，同時對於乳癌放射治療的早期與晚期副作用亦有所探討。

關鍵字

放射線治療 ； 乳癌 ； 復發 ； 併發症

並列摘要

Radiotherapy has been used as an important part of breast cancer treatment for more than 100 years. In the early days, the application of radiotherapy in breast cancer treatment was mainly for the recurrent disease after mastectomy or for inoperable disease. Nowadays, radiotherapy has evolved to be an essential component as adjuvant treatment for patients with breast conservative surgery and for patient with mastectomy who are at high risk for local failure. The type of radiotherapy, whole breast irradiation or chest wall irradiation, given after surgery for breast cancer varies with the primary surgical procedures. Moderate radiation dose given after breast conservative therapy eradicates any foci of residual microscopic disease, subsequently provides large reduction in the local recurrence rate and a benefit on survival. Similarly, post-mastectomy chest wall irradiation reduces the risk of locoregional failure, increases disease-free survival and reduces risk of dying from breast cancer. Optimal local management of breast cancer requires a collaborative effort between surgeons, radiation and medical oncologists. This multimodality approach permits the coordination of surgery and radiation therapy, and the optimal integration of both local and systemic therapies. Indications and techniques of radiotherapy for breast cancer are reviewed here. Furthermore, the complications of radiotherapy are also discussed.

並列關鍵字

radiotherapy ； breast cancer ； recurrence ； complications