乳腺癌放射性皮炎的风险识别、诊断技术及防治策略研究进展

Research Progress on Risk Identification, Diagnostic Techniques, and Prevention and Management Strategies for Radiation Dermatitis in Breast Cancer

摘要: 放射性皮炎(radiation dermatitis, RD)是乳腺癌患者放疗期间最常见的急性不良反应，发生率高达95%，其不仅会降低患者治疗依从性，还会严重影响生活质量。本文围绕RD的风险识别、新型诊断技术及防治策略展开综述，梳理相关研究进展：在风险识别方面，已明确身体质量指数 ≥ 25 kg/m²、吸烟、糖尿病及特定基因多态性为宿主风险因素；在新型诊断技术领域，反射式共聚焦显微镜、皮肤反射光谱法、光声成像与弹性成像技术，以及分子与血清标志物检测技术的应用，实现了RD的早期、定量及客观诊断，诊断效能显著优于传统视觉评估方法；在防治策略上，调强放疗、大分割放疗等放疗技术可有效降低皮肤受照剂量，局部屏障保护措施与糖皮质激素、细菌去定植等药物干预均为临床证实的有效防治手段。未来需依托精准风险识别体系与新型诊断技术，进一步优化个体化防治方案，持续提升RD的临床管理效果。

Abstract: Radiation dermatitis (RD) is the most common acute adverse reaction in breast cancer patients undergoing radiotherapy, with an incidence rate as high as 95%. It not only reduces patients’ treatment compliance but also severely impairs their quality of life. This article reviews the research progress focusing on RD’s risk identification, novel diagnostic techniques, and prevention and management strategies: In terms of risk identification, body mass index (BMI) ≥ 25 kg/m², smoking, diabetes mellitus, and specific gene polymorphisms have been identified as key host risk factors. In the field of novel diagnostic technologies, the application of reflectance confocal microscopy, skin reflectance spectrophotometry, photoacoustic imaging, elastography, as well as molecular and serum marker detection technologies has enabled early, quantitative, and objective diagnosis of RD, with diagnostic efficacy significantly superior to traditional visual assessment methods. Regarding prevention and management strategies, radiotherapy techniques such as intensity-modulated radiation therapy (IMRT) and hypofractionated radiotherapy can effectively reduce skin radiation dose, while local barrier protection measures and pharmacological interventions including glucocorticoids and bacterial decolonization have been clinically proven as effective prevention and treatment approaches. Future efforts should rely on precise risk identification systems and novel diagnostic technologies to further optimize individualized prevention and treatment regimens, continuously improving the clinical management outcomes of RD.