乳腺癌放射治疗面临的挑战部分乳腺的短程治疗保乳手术及全乳照射后乳腺内复发部位IBTR克隆源性分子生物学检测部分乳腺的短程治疗WilliamBeaumontHospital,2000年Vicinietal.乳腺APBI12年结果乳腺肿块切除术后单独近距离治疗(TBRT)和全乳腺照射(WBRT)的比较（PolgarCetal.2002)BudapestIII期试验4年结果3D-CRTAPBI3–yrResultsofRTOG-0319Vicinietal.IJROBP2008;72(S1):S3中位随访期:3.5年（1.6-4.2）勾画瘤床的方法：肿瘤切除术后的残腔术中在瘤床处置放的Clips术前、术后CT图象融合方法CT及Clips确定瘤床的研究根据CT密度改变确定瘤床有很大的可变性（有的有明显异常，有的则无）CT和Clips确定的瘤床往往不一致CT和Clips定出的几何中心可有明显差异CT和Clips定出的瘤床范围也不一致，Clips的要小于CT单用Clips来确定Boot照射野可能不够准确瘤床区域随着时间延长会收缩，究竟是任何时候都能用此作加量计划还是在术后立即作计划尚无定论HOWTOBOOSTTHEBREASTTUMORBED?YouliaM.etal.InstituteCurie,Paris,France.IJROBP2008T1-2N+1-3乳癌改良根治术及化疗后是否还需作PMRT乳腺癌改良根治术及辅助化疗后10年局部—区域复发率GuidelineorConsensusConsensusStatementonpostmastectomyradiationtherapy.IJROBP1999;44:989.Postmastectomyradiotherapy:clinicalpracticeguidelinesoftheAmericanSocietyofClinicalOncology.JCO2001;19:1539.NationalInstitutesofHealthConsensusDevelopmentConferenceStatement:adjuvanttherapyforbreastcancer.JNCI2001;93:979.EUSOMAWorkingParty.Thecurativeroleofradiotherapyinthetreatmentofoperablebreastcancer.EurJCancer2002;38:1961-74.Meetinghighlights:updatedinternationalexpertconsensusontheprimarytherapyofearlybreastcancer.JCO2003;21:3357-65.Clinicalpracticeguidelinesforthecareandtreatmentofbreastcancer:16,Locoregionalpostmastectomyradiotherapy.CMAT2004;170:1263-73.Meetinghighlights:internationalexpertconsensusontheprimarytherapyofearlybreastcancer2005.AnnOncol2005;16:1569-83.上述文件均不推荐对LN+1-3患者作PMRTDBCG82b&CLN+1-3组放疗疗效OvergaadMetal.RadiotherOncol2007;82:247CN+1-3CN+≥4RT(-)RT(+)RT(-)RT(+)局部-区域复发率27%4%P<0.00151%10%P<0.00115年生存率48%57%P<0.0312%21%P<0.03Therecommendationforchestwallandsupraclavicularirradiationinwomenwith1-3involvedaxillarylymphnodesgeneratedsubstantialcontroversyamongpanelmembers.Somepanelmembersbelievechestwallandsupraclavicularirradiationshouldbeusedroutinelyaftermastectomyandchemotherapyinthissubgroupofpatients.However,otherpanelmembersbelieveradiationshouldbeconsideredinthissettingbutshouldnotbemandatorygiventhestudiesth