Chadha Manjeet, Trombetta Mark, Boolbol Susan, Osborne Michael P
Department of Radiation Oncology, Beth Israel Medical Center, USA.
Oncology (Williston Park). 2009 Oct;23(11):933-40.
Over the past 30 years, lumpectomy and radiation therapy (breast-conservation therapy, or BCT) has been the preferred treatment for early-stage breast cancer. With accumulating follow-up, we have an ever-expanding pool of patients with history of an irradiated intact breast. Routine use of every-6-month or annual screening in this population has identified an emerging clinical dilemma with respect to managing a small recurrence or a second primary tumor in the treated breast. Most women diagnosed with a second cancer in a previously irradiated breast are advised to undergo mastectomy. More recently, with an improved understanding of the patterns of in-breast failure, and with advances in the delivery of conformal radiation dose there is an opportunity to reevaluate treatment alternatives for managing a small in-breast recurrence. A limited number of publications have reported on patient outcomes after a second lumpectomy and radiation therapy for this clinical scenario. In this report, we review the controversial subject of a second chance at breast conservation for women with a prior history of breast irradiation.
在过去30年里，保乳手术和放射治疗（保乳治疗，即BCT）一直是早期乳腺癌的首选治疗方法。随着随访的积累，我们有了越来越多接受过放射治疗的完整乳房病史的患者群体。在这一人群中常规每6个月或每年进行筛查，发现了在处理治疗过的乳房中的小复发或第二原发性肿瘤方面出现了一个新的临床困境。大多数在先前接受过放射治疗的乳房中被诊断出患有第二种癌症的女性被建议接受乳房切除术。最近，随着对乳房内复发模式的进一步了解，以及适形放射剂量输送技术的进步，有机会重新评估处理乳房内小复发的治疗选择。少数出版物报道了在这种临床情况下二次保乳手术和放射治疗后的患者结局。在本报告中，我们回顾了有乳房放疗史的女性获得二次保乳机会这一有争议的话题。
