Fatouros Michael, Roukos Dimitrios H, Arampatzis Ioannis, Sotiriadis Alexandros, Paraskevaidis Evangelos, Kappas Angelos M
Department of Surgery, Ioannina University School of Medicine, Ioannina 451 10, Greece.
Expert Rev Anticancer Ther. 2005 Aug;5(4):737-45. doi: 10.1586/14737140.5.4.737.
From 20-year follow-up results of two pioneering randomized controlled trials demonstrating equal survival after mastectomy and breast-conservation therapy, recent high-quality, evidence-based clinical practice recommendations have been made. Breast-conservation therapy undoubtedly represents substantial progress for a better quality of life for women with early-stage breast cancer. However, lumpectomy is associated with a substantial proportion, approximately 10-20%, of local recurrence in long-term follow-up studies even after accounting for postoperative radiotherapy. Risk factors for local failure include margin status, young age and an extensive intraductal component. Young age and family history strongly suggest the need for genetic testing before initiation of treatment. Women with BRCA1 or BRCA2 mutations should be informed about the increased risk of contralateral breast cancer and ipsilateral failure after breast-conservation therapy. Bilateral mastectomy should also be offered as a treatment option. There is controversy over whether current effective adjuvant treatment, including chemotherapy and endocrine therapy, beyond appropriate local treatment as surgery and radiotherapy, can improve local control. Instead of debate over whether an ipsilateral tumor after breast-conservation therapy is local recurrence or a new primary cancer by analyzing conflicting data lacking strong evidence, efforts should be focused on reducing this risk irrespective of origin. Selecting women for breast-conservation therapy and achieving margin control can reduce ipsilateral failures.
两项开创性随机对照试验的20年随访结果表明，乳房切除术和保乳治疗后的生存率相当，近期已出台了高质量、循证临床实践建议。保乳治疗无疑代表着早期乳腺癌女性生活质量改善方面的重大进展。然而，在长期随访研究中，即使考虑术后放疗，肿块切除术仍有相当比例（约10%-20%）的局部复发。局部失败的危险因素包括切缘状态、年轻和广泛的导管内成分。年轻和家族史强烈提示在开始治疗前需要进行基因检测。携带BRCA1或BRCA2突变的女性应被告知保乳治疗后对侧乳腺癌和同侧失败风险增加。双侧乳房切除术也应作为一种治疗选择提供。对于除手术和放疗等适当局部治疗外的当前有效辅助治疗（包括化疗和内分泌治疗）是否能改善局部控制存在争议。不应通过分析缺乏有力证据的相互矛盾的数据来争论保乳治疗后同侧肿瘤是局部复发还是新发原发性癌症，而应无论其来源如何，都致力于降低这种风险。选择适合保乳治疗的女性并实现切缘控制可减少同侧失败。
