Rutqvist L E
Oncologic Centre, Radiumhemmet, Karolinska Hospital, Stockholm, Sweden.
Med Oncol Tumor Pharmacother. 1991;8(3):163-8. doi: 10.1007/BF02987175.
The paper provides a brief summary of the scientific hypotheses underlying adjuvant trials of systemic treatment in primary breast cancer, the history of the first and second generation of adjuvant studies of cytotoxic and endocrine therapy, and a brief description of the main findings of the international overview of all available randomized trials of adjuvant systemic treatment. In short, the overview has provided conclusive evidence that both adjuvant endocrine therapy (ovarian ablation and tamoxifen) as well as cytotoxic polychemotherapy can prevent disease recurrence and prolong overall survival. However, the treatment benefit appears to be only moderate and may not be considered clinically worthwhile in some patient subsets, e.g. those with a relatively favourable outcome with local treatment alone. Refinements in the use of prognostic factors to select patients for treatment--particularly in node-negative disease--are thus warranted, as well as further research aimed at improving treatment efficacy.
本文简要总结了原发性乳腺癌全身治疗辅助试验的科学假说、细胞毒性和内分泌治疗第一代及第二代辅助研究的历史，并简要描述了辅助全身治疗所有可用随机试验国际综述的主要发现。简而言之，该综述提供了确凿证据，表明辅助内分泌治疗（卵巢去势和他莫昔芬）以及细胞毒性多药化疗均可预防疾病复发并延长总生存期。然而，治疗获益似乎仅为中等程度，在某些患者亚组中，例如那些仅接受局部治疗预后相对良好的患者，可能不被认为具有临床价值。因此，有必要优化使用预后因素来选择治疗患者——尤其是在淋巴结阴性疾病中——以及开展旨在提高治疗疗效的进一步研究。
