rpmjResearch'n Practical Medicine JournalResearch and Practical Medicine Journal2410-1893"QUASAR", LLC10.17709/2409-2231-2017-4-3-6rpmj-201Research ArticleОбзорыReviewУСКОРЕННЫЕ РЕЖИМЫ АДЪЮВАНТНОЙ ЛУЧЕВОЙ ТЕРАПИИ В ЛЕЧЕНИИ РАКА МОЛОЧНОЙ ЖЕЛЕЗЫACCELERATED REGIMENS OF ADJUVANT RADIOTHERAPY IN THE TREATMENT OF BREAST CANCERhttps://orcid.org/0000-0002-7128-2397АфонинГ. В.AfoninG. V.

аспирант, врач-онколог отделения лучевого и хирургического лечения заболеваний торакальной области,

249031, Калужская область, Обнинск, ул. Маршала Жукова, д. 10

post-graduate student, oncologist of the Department of Radiation and Surgical Treatment of Thoracic Diseases,

10 Marshala Zhukova str., Kaluga Region, Obninsk, 249036

https://orcid.org/0000-0001-5352-9248РагулинЮ. А.RagulinYu. A.

к.м.н., заведующий отделением лучевого и хирургического лечения заболеваний торакальной области,

249031, Калужская область, Обнинск, ул. Маршала Жукова, д. 10

PhD, Head of the Department of Radiation and Surgical Treatment of Thoracic Diseases,

10 Marshala Zhukova str., Kaluga Region, Obninsk, 249036

yuri.ragulin@mail.ruhttps://orcid.org/0000-0002-2759-297XГулидовИ. А.GulidovI. A.

д.м.н., профессор, заведующий отделом лучевой терапии

MD, Professor, Head of the Department of Radiation Therapy,

10 Marshala Zhukova str., Kaluga Region, Obninsk, 249036

Медицинский радиологический научный центр им. А.Ф. Цыба – филиал ФГБУ «Национальный медицинский исследовательский центр радиологии» Минздрава РоссииРоссияA. Tsyb Medical Radiological Research Centre – Branch of the National Medical Radiology Research Centre of the Ministry of Health of the Russian FederationRussian Federation201720092017436674Copyright © Афонин Г.В., Рагулин Ю.А., Гулидов И.А., 20172017Афонин Г.В., Рагулин Ю.А., Гулидов И.А.Afonin G.V., Ragulin Y.A., Gulidov I.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.rpmj.ru/rpmj/article/view/201

Лечение рака молочной железы (РМЖ) является сложной мультидисциплинарной проблемой. Зачастую обязательным компонентом лечения больных РМЖ является лучевая терапия. Многочисленными крупными рандомизированными исследованиями доказана эффективность адъювантной лучевой терапии как в стандартном режиме фракционирования в разовой очаговой дозе 2 Гр до суммарной очаговой дозы 50 Гр за 25 фракций, так и в режимах гипофракционирования, использующих лучевое воздействие в большей суточной дозе с уменьшением общего времени лечения. В представленном обзоре обобщены данные наиболее крупных исследований по изучению режимов гипофракционирования послеоперационной лучевой терапии РМЖ. Большинство работ, сравнивающих стандартный режим фракционирования послеоперационной лучевой терапии с режимами гипофракционирования, продемонстрировали сопоставимые результаты по основным онкологическим показателям при сходной переносимости, частоте осложнений и хороших косметических результатах. Также показана экономическая целесообразность применения ускоренных режимов в повседневной практике. Несмотря на то что лучевая терапия в режиме гипофракционирования стала уже стандартом лечения и рекомендуется к применению крупнейшими европейскими и американскими онкологическими ассоциациями, показания к ее проведению, критерии отбора в исследования и диапазон рекомендуемых разовых очаговых доз отличаются. Полученные результаты не дают возможности уверенно судить о преимуществе того или иного режима. Необходимо определить факторы благоприятного и неблагоприятного прогноза, уточнить показания к использованию различных методик лучевой терапии. Поэтому вопросы об оптимальном режиме гипофракционирования адъювантной лучевой терапии, сроках ее начала и критериях отбора больных для данного вида терапии в составе комплексного лечения РМЖ пока до конца не решены. Также открытым является выбор оптимальных разовых и суммарных доз облучения, его сочетание с лекарственной терапией.

Treatment of breast cancer (BC) is a complex multidisciplinary problem. Often, radiation therapy is an obligatory component of treatment of breast cancer patients. Numerous large randomized trials have proved the efficacy of adjuvant radiotherapy in both the standard fractionation regimen in a single focal dose of 2 Gy to a total focal dose of 50 Gy for 25 fractions and in modes of hypofractionation using radiation exposure at a larger daily dose with a reduction in the total treatment time. The presented review summarizes the data of the largest studies on the modes of hypofractionation of postoperative radiotherapy for breast cancer. Most of the studies comparing the standard mode of fractionation of postoperative radiotherapy with the modes of hypofractionation showed comparable results for the main oncological parameters with similar tolerability, frequency of complications and good cosmetic results. It also shows the economic feasibility of applying accelerated regimes in everyday practice. Despite the fact that radiotherapy in the mode of hypofractionation has already become the standard of treatment and is recommended for use by the largest European and American cancer associations, indications for its conduct, the criteria for selection in the studies and the range of recommended single focal doses differ. The obtained results do not give an opportunity to confidently judge the advantage of one or another regime. It is necessary to determine the factors of a favorable and unfavorable prognosis, to clarify the indications for the use of various radiotherapy techniques. Therefore, questions about the optimal mode of hypo-fractionation of adjuvant radiotherapy, the timing of its initiation and the criteria for selecting patients for this type of therapy as part of the comprehensive treatment of breast cancer have not yet been fully resolved. Also open is the choice of optimal single and total doses of radiation, its combination with drug therapy.

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The authors declare that there are no conflicts of interest present.