HER2 阳性乳腺癌术前全身靶向治疗 (PST) 后区域淋巴结照射 (RNI) 的作用仍不确定。本研究旨在探讨 RNI 对多西紫杉醇/卡铂/曲妥珠单抗/帕妥珠单抗 (TCHP) 进行 PST 后局部复发 (LRR) 和无病生存 (DFS) 结果的影响。我们回顾性分析了 255 名接受 6 个周期治疗的患者。 2016年至2019年期间进行的TCHP。根据临床淋巴结受累情况将患者分为四组：A组，无淋巴结病变；A组，无淋巴结病变；A组，无淋巴结病变。 B组，腋窝淋巴结（AXL）I级； C组，AXL I级和II/III级；和 D 组，有锁骨上或内乳淋巴结。RNI 组比无 RNI 组有更严重的淋巴结疾病 (C/D)（56.9% vs. 6.8%）。中位随访时间为 51.3 个月，分别有 2 例 (0.8%)、3 例 (1.2%) 和 15 例 (5.9%) 局部、区域和远处转移。根据 RNI，LRR 没有显着差异（2.6% 与 1.0%，p = 0.651）。 D 组远处转移最常见（17.5%；p = 0.005）。 4 年 DFS 率为 92.7%，RNI 后 DFS 没有显着改善 (p = 0.074)。当按临床淋巴结组和病理腋窝反应分层时，RNI 对 LRR/DFS 结果没有影响。由于 LRR 发生率很少，RNI 对 HER2 阳性乳腺癌患者 PST-TCHP 后的 LRR 或 DFS 没有显着影响。然而，晚期疾病（C/D）需要强化全身治疗。在未来的研究中应研究选择性去强化 RNI 和强化全身治疗。版权所有 © 2023 作者。由爱思唯尔有限公司出版。保留所有权利。

The role of regional nodal irradiation (RNI) after preoperative systemic treatment (PST) with targeted therapy for HER2-positive breast cancer remains uncertain. This study aimed to investigate the impact of RNI on locoregional recurrence (LRR) and disease-free survival (DFS) outcomes after docetaxel/carboplatin/trastuzumab/pertuzumab (TCHP) for PST.We retrospectively analyzed 255 patients who were treated with six cycles of TCHP between 2016 and 2019. The patients were divided into four groups based on clinical nodal involvement: group A, with no nodal disease; group B, with axillary lymph node (AXL) level I; group C, with AXL level I with II/III; and group D, with supraclavicular or internal mammary nodes.The RNI group had more advanced nodal disease (C/D) than the no RNI group (56.9 % vs. 6.8 %). With a median follow-up of 51.3 months, there were two (0.8 %), three (1.2 %), and 15 (5.9 %) local, regional, and distant metastases, respectively. LRR did not differ significantly according to the RNI (2.6 % vs. 1.0 %, p = 0.651). Group D had the most frequent distant metastases (17.5 %; p = 0.005). The 4-year DFS rate was 92.7 %, and DFS did not improve significantly after RNI (p = 0.074). When stratified by clinical nodal groups and pathological axillary response, RNI had no effect on LRR/DFS outcomes.With a rare incidence of LRR, RNI did not significantly affect LRR or DFS in patients with HER2-positive breast cancer after with PST-TCHP. However, intensive systemic treatment is required for advanced diseases (C/D). Selective de-intensified RNI and intensified systemic treatment should be investigated in future studies.Copyright © 2023 The Authors. Published by Elsevier Ltd.. All rights reserved.