Mannino Mariella, Yarnold John R
Royal Marsden Hospital, Department of Clinical Oncology, Surrey, UK.
Radiother Oncol. 2009 Jan;90(1):14-22. doi: 10.1016/j.radonc.2008.05.002. Epub 2008 May 24.
Rates of local tumour relapse after breast conservation treatment in women with early breast cancer are falling. Explanations for this decline are considered in this review including advances in breast cancer management and aging of the breast cancer population. Breast surgery has become more standardised following publication of practice guidelines and is mostly carried out by specialist surgeons. Systemic therapies (hormonal therapy and chemotherapy) are now more effective and are recommended to a higher proportion of patients than ever before. Radiotherapy techniques have also improved. The contributions of each factor are difficult to quantify precisely, but all are likely to be relevant. In order to identify a subgroup of women that might safely be spared radiotherapy, several factors are analysed, including the prognostic significance for local relapse of tumour characteristics (pathologic data, gene-expression profiles), patient characteristics and life expectancy (age and comorbidities).
早期乳腺癌女性保乳治疗后局部肿瘤复发率正在下降。本综述探讨了这种下降的原因，包括乳腺癌治疗进展和乳腺癌患者群体老龄化。实践指南发布后，乳房手术变得更加标准化，且大多由专科外科医生进行。全身治疗（激素治疗和化疗）现在更有效，推荐给患者的比例也比以往更高。放疗技术也有所改进。每个因素的贡献难以精确量化，但所有因素可能都与之相关。为了确定可能安全免除放疗的女性亚组，分析了几个因素，包括肿瘤特征（病理数据、基因表达谱）对局部复发的预后意义、患者特征和预期寿命（年龄和合并症）。
