AIRO Breast Cancer Group Best Clinical Practice 2022 Update

被引：26

作者：

Ciabattoni, Antonella ^{[1
]}

Gregucci, Fabiana ^{[2
]}

De Rose, Fiorenza ^{[3
]}

Falivene, Sara ^{[4
]}

Fozza, Alessandra ^{[5
]}

Daidone, Antonio ^{[6
]}

Morra, Anna ^{[7
]}

Smaniotto, Daniela ^{[8
]}

Barbara, Raffaele ^{[9
]}

Lozza, Laura ^{[10
]}

Vidali, Cristiana ^{[11
]}

Borghesi, Simona ^{[12
]}

Palumbo, Isabella ^{[13
,14
]}

Huscher, Alessandra ^{[15
]}

Perrucci, Elisabetta ^{[16
]}

Baldissera, Antonella ^{[17
]}

Tolento, Giorgio ^{[18
]}

Rovea, Paolo ^{[19
]}

Franco, Pierfrancesco ^{[20
]}

De Santis, Maria Carmen ^{[10
]}

Di Grazia, Alfio ^{[21
]}

Marino, Lorenza ^{[21
]}

Meduri, Bruno ^{[22
]}

Cucciarelli, Francesca ^{[23
]}

Aristei, Cynthia ^{[13
,14
]}

Bertoni, Filippo ^{[24
]}

Guenzi, Marina ^{[25
]}

Leonardi, Maria Cristina ^{[29
]}

Livi, Lorenzo ^{[26
,27
]}

Nardone, Luigia ^{[28
]}

De Felice, Francesca ^{[28
]}

Rosetto, Maria Elena ^{[30
]}

Mazzuoli, Lidia ^{[30
]}

Anselmo, Paola ^{[31
]}

Arcidiacono, Fabio ^{[31
]}

Barbarino, Rosaria ^{[32
]}

Martinetti, Mariateresa ^{[33
]}

Pasinetti, Nadia ^{[34
,35
]}

Desideri, Isacco ^{[26
,27
]}

Marazzi, Fabio ^{[8
]}

Ivaldi, Giovanni ^{[36
]}

Bonzano, Elisabetta ^{[37
,38
]}

Cavallari, Monica ^{[39
]}

Cerreta, Vincenzo ^{[40
]}

Fusco, Vincenzo ^{[41
]}

Sarno, Laura ^{[42
]}

Bonanni, Alessio ^{[43
]}

Mangiacotti, Maria Grazia ^{[44
]}

Prisco, Agnese ^{[45
]}

Buonfrate, Giovanna ^{[46
]}

机构：

[1] ASL Roma I, UOC Radioterapia, PO San Filippo Neri, I-00135 Rome, Italy

[2] Osped Gen Reg F Miulli, UOC Radioterapia Oncol, Acquaviva Delle Fonti, BA, Italy

[3] Osped Santa Chiara, UO Radioterapia Oncol, Trento, Italy

[4] Ist Nazl Tumori IRCCS Fdn G Pascale, SC Radioterapia, Naples, Italy

[5] IRCCS Osped Policlin San Martino, UO Radioterapia Oncol, Genoa, Italy

[6] UO Radioterapia Oncol, Palermo, PA, Italy

[7] Ist Europeo Oncol, Div Radioterapia Oncol, Milan, Italy

[8] Fdn Policlin Univ A Gemelli IRCCS, UOC Radioterapia Oncol, Rome, Italy

[9] ARNAS G Brotzu PO Businco, UOC Radioterapia Oncol Dipartimento Oncol Interni, Cagliari, Italy

[10] Fdn IRCCS Ist Nazl Tumori Milano, SC Radioterapia 1, Milan, Italy

[11] Azienda Sanitaria Univ Integrata Trieste, Radioterapia Oncol, Trieste, Italy

[12] Azienda USL Toscana Sud Est, UO Radioterapia Oncol Arezzo Valdarno, Arezzo, Italy

[13] Univ Perugia, Sez Radioterapia Oncol, Perugia, Italy

[14] Azienda Osped Perugia, Perugia, Italy

[15] Fdn Poliambulanza, Radioterapia Oncol, Brescia, Italy

[16] Azienda Osped Perugia, SC Radioterapia Oncol, Perugia, Italy

[17] Osped Bellaria, UO Radioterapia, Bologna, Italy

[18] IRCCS Azienda Osped Univ Bologna, Radioterapia Oncol, Bologna, Italy

[19] Azienda Osped Univ Citta Salute & Sci, Radioterapia Oncol, Turin, Italy

[20] Univ Piemonte Orientale, Dipartimento Med Traslaz DIMET, Novara, Italy

[21] Ist Clin Catanese, Radioterapia Humanitas, Catania, Italy

[22] Azienda Osped Univ Modena, Dipartimento Radioterapia Oncol, Modena, Italy

[23] Azienda Osped Univ, Osped Riuniti Ancona, UO Radioterapia, Ancona, Italy

[24] Assoc Italiana Radioterapia & Oncol Clin, Radioterapia Oncol, Rome, Italy

[25] IRCCS Policlin San Martino & Univ, Radioterapia Oncol, Genoa, Italy

[26] Univ Firenze, Dipartimento Sci Biomed Sperimentali & Clin M Ser, Florence, Italy

[27] Azienda Osped Univ Careggi AOUC, Dipartimento Oncol, Radioterapia Oncol, Careggi, Italy

[28] Fdn Policlin Univ A Gemelli IRCCS, U0C Radioterapia Oncol, Rome, Italy

[29] Sapienza Univ Roma, Azienda Osped Univ Policlin Umberto 1, Dipartimento Radioterapia, Rome, Italy

[30] Osped Belcolle, UOC Radioterapia, Viterbo, Italy

[31] Azienda Osped S Maria, SC Radioterapia Oncol, Terni, Italy

[32] Fdn Policlin Tor Vergata, UOC Radioterapia, Rome, Italy

[33] Osped Ca Foncello, UOC Radioterapia, Treviso, Italy

[34] ASST Valcamonica Esine, Serv Radioterapia, Esine, BS, Italy

[35] Univ Brescia, Esine, BS, Italy

[36] ICS Maugeri SpA SB IRCCS, UO Radioterapia, Pavia, Italy

[37] Univ Pavia, Med Sperimentale, Pavia, Italy

[38] Policlin San Matteo, Fdn IRCCS, Dipartimento Radioterapia Oncol, Pavia, Italy

[39] SC Radioterapia EO Osped Galliera, Genoa, Italy

[40] Policlin Monza, SC Radioterapia, Monza, Italy

[41] IRCCS CROB Rionero Vulture, UOC Radioterapia Oncol, Potenza, Italy

[42] ASST Grande Osped Metropolitano Niguarda, SC Radioterapia, Milan, Italy

[43] Osped S Giovanni Calibita Fatebenefratelli Isola, UOC Radioterapia Oncol, Rome, Italy

[44] Osped Gen Prov San Camillo De Lellis, UOC Radioterapia, Rieti, Italy

[45] Azienda Osped Univ S Maria della Misericordia, Dipartimento Radioterapia Oncol, Udine, Italy

[46] Azienda USL Toscana Sud Est, Osped Misericordia, UOC Radioterapia, Grosseto, Italy

[47] Oncol Azienda Osped San Giovanni Addolorata, UOC Radioterapia, Rome, Italy

[48] Osped S Maria Goretti, SC Radioterapia Oncol, Latina, Italy

[49] Azienda USL Toscana Nord Ovest, Osped San Luca, Area Omogenea Radioterapia, SC Radioterapia, Lucca, Italy

[50] Fdn Policlin Univ Campus Biomed, Radioterapia Oncol, Rome, Italy

来源：

TUMORI JOURNAL | 2022年 / 108卷 / 2_SUPPL期

关键词：

Breast cancer; Radiation therapy; Best clinical practice; Evidence-based medicine;

D O I：

10.1177/03008916221088885

中图分类号：

R73 [肿瘤学];

学科分类号：

100214 ;

摘要：

Introduction: Breast cancer is the most common tumor in women and represents the leading cause of cancer death. Radiation therapy plays a key-role in the treatment of all breast cancer stages. Therefore, the adoption of evidence-based treatments is warranted, to ensure equity of access and standardization of care in clinical practice. Method: This national document on the highest evidence-based available data was developed and endorsed by the Italian Association of Radiation and Clinical Oncology (AIRO) Breast Cancer Group. We analyzed literature data regarding breast radiation therapy, using the SIGN (Scottish Intercollegiate Guidelines Network) methodology (www.sign.ac.uk). Updated findings from the literature were examined, including the highest levels of evidence (meta-analyses, randomized trials, and international guidelines) with a significant impact on clinical practice. The document deals with the role of radiation therapy in the treatment of primary breast cancer, local relapse, and metastatic disease, with focus on diagnosis, staging, local and systemic therapies, and follow up. Information is given on indications, techniques, total doses, and fractionations. Results: An extensive literature review from 2013 to 2021 was performed. The work was organized according to a general index of different topics and most chapters included individual questions and, when possible, synoptic and summary tables. Indications for radiation therapy in breast cancer were examined and integrated with other oncological treatments. A total of 50 questions were analyzed and answered. Four large areas of interest were investigated: (1) general strategy (multidisciplinary approach, contraindications, preliminary assessments, staging and management of patients with electronic devices); (2) systemic therapy (primary, adjuvant, in metastatic setting); (3) clinical aspects (invasive, non-invasive and micro-invasive carcinoma; particular situations such as young and elderly patients, breast cancer in males and cancer during pregnancy; follow up with possible acute and late toxicities; loco-regional relapse and metastatic disease); (4) technical aspects (radiation after conservative surgery or mastectomy, indications for boost, lymph node radiotherapy and partial breast irradiation). Appendixes about tumor bed boost and breast and lymph nodes contouring were implemented, including a dedicated web application. The scientific work was reviewed and validated by an expert group of breast cancer key-opinion leaders. Conclusions: Optimal breast cancer management requires a multidisciplinary approach sharing therapeutic strategies with the other involved specialists and the patient, within a coordinated and dedicated clinical path. In recent years, the high-level quality radiation therapy has shown a significant impact on local control and survival of breast cancer patients. Therefore, it is necessary to offer and guarantee accurate treatments according to the best standards of evidence-based medicine.

引用

页码：1 / 144

页数：144

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