Nos C, Bourgeois D, Darles C, Asselain B, Campana F, Zafrani B, Durand J C, Clough K
Service de chirurgie générale, Institut Curie, 26, rue d'Ulm, 75231 Paris Cedex 05.
Bull Cancer. 1999 Feb;86(2):184-8.
Conservative treatment of multifocal breast cancer is still very controversial. This retrospective study concerns 56 patients with stage I or II multifocal breast cancer who underwent conservative treatment at the Institut Curie from January 1983 to December 1989. These patients (group 1) were matched with 132 patients with multifocal lesions treated by mastectomy (group 2). Surgical treatment consisted of a single wide lumpectomy followed by external radiotherapy. Adjuvant systemic therapy and regional nodal irradiation were administered as indicated by current protocols. The actuarial 5-year overall survival rate was 94% 6 in group 1, and 90% 6 in group 2 (NS). The actuarial 5-year ipsilateral breast recurrence rate was 11% 8 in group 1, and 11% 5 in group 2 (NS). In group 1 patients, the ipsilateral breast recurrence rate was related neither to type of multifocality nor to presence of intra ductal breast carcinoma, nodal status, tumor margins, radiotherapy boost, or distance between tumors. Consequently, conservative treatment of multifocal breast cancers which can be completely removed by a single lumpectomy seems, when technically feasible, an alternative to mastectomy.
多灶性乳腺癌的保守治疗仍存在很大争议。这项回顾性研究涉及1983年1月至1989年12月期间在居里研究所接受保守治疗的56例I期或II期多灶性乳腺癌患者。这些患者（第1组）与132例接受乳房切除术治疗的多灶性病变患者（第2组）进行匹配。手术治疗包括单次广泛肿块切除术，随后进行体外放疗。根据当前方案进行辅助全身治疗和区域淋巴结照射。第1组的5年总生存率精算值为94%，第2组为90%（无显著性差异）。第1组的5年同侧乳房复发率精算值为11%，第2组为11%（无显著性差异）。在第1组患者中，同侧乳房复发率与多灶性类型、导管内乳腺癌的存在、淋巴结状态、肿瘤切缘、放疗加强或肿瘤之间的距离均无关。因此，对于可通过单次肿块切除术完全切除的多灶性乳腺癌，在技术可行时，保守治疗似乎可作为乳房切除术的替代方案。
