Mieog J S D, van Nes J G H, van de Velde C J H
Leids Universitair Medisch Centrum, afd. Heelkunde, Leiden.
Ned Tijdschr Geneeskd. 2008 Nov 15;152(46):2501-6.
Neoadjuvant systemic therapy is administered preoperatively in order to provide a better preparation for surgery by down sizing the tumour. A recent meta-analysis comparing neoadjuvant and adjuvant chemotherapy demonstrated a 17% (95% CI: 15.1-18.1) increase in breast-conserving operations with equal survival rates and maintenance of local control providing adequate surgery was performed. Comparable results have been reported with neoadjuvant hormonal therapy. However, in the case of hormonal therapy the tumour-shrinking effects persisted when treatment was sustained. Research has shown that the sentinel lymph node procedure continues to be reliable after neoadjuvant therapy. Therefore, axillary lymph node dissection is not necessary if the lymph node metastases have disappeared as a result of the neoadjuvant therapy: down staging. However, further research is needed to confirm the safety of this treatment approach. Assessment oftumour sensitivity during neoadjuvant therapy facilitates analysis of the prognostic value of tumour markers. The aim of this translational research is to provide better selection criteria to identify patients in which the systemic treatment will be beneficial.
新辅助全身治疗在术前进行，目的是通过缩小肿瘤体积为手术提供更好的准备。最近一项比较新辅助化疗和辅助化疗的荟萃分析表明，在生存率相同且局部控制得以维持（前提是进行了充分的手术）的情况下，保乳手术的比例增加了17%（95%置信区间：15.1 - 18.1）。新辅助激素治疗也报告了类似的结果。然而，就激素治疗而言，持续治疗时肿瘤缩小效果会持续存在。研究表明，新辅助治疗后前哨淋巴结活检仍然可靠。因此，如果新辅助治疗使淋巴结转移消失（降期），则无需进行腋窝淋巴结清扫。然而，需要进一步研究来证实这种治疗方法的安全性。评估新辅助治疗期间肿瘤的敏感性有助于分析肿瘤标志物的预后价值。这项转化研究的目的是提供更好的选择标准，以识别那些将从全身治疗中获益的患者。
