Benson John R, Teo Katy A T
Cambridge Breast Unit, Addenbrooke's Hospital, Hills Road, Cambridge, CB2 0QQ, UK.
World J Surg. 2012 Jul;36(7):1460-74. doi: 10.1007/s00268-012-1468-5.
Until recently, the concept of biological predeterminism appeared pre-eminent and a worthy successor to the Halstedian doctrine of centrifugal spread of cancer. However, evidence has now emerged from clinical trials to cast doubt on the universal application of this concept to breast tumors. Prevention of local recurrence can save lives, local control does matter, and rates of local recurrence should be minimized in the first 5 years. In up to one quarter of cases of local recurrence the locally recurring disease will be a determinant and not simply a marker of risk for distant relapse and death. Both types of local recurrence are manifestations of the same biological processes and reflect intrinsic behavior of the tumor. This principle applies to reduction in local relapse from both adjuvant radiotherapy and surgical modalities.
直到最近，生物预定论的概念似乎占据主导地位，是霍尔斯特德癌症离心扩散学说的一个值得继承的学说。然而，现在临床试验的证据对这一概念在乳腺肿瘤中的普遍应用提出了质疑。预防局部复发可以挽救生命，局部控制很重要，并且应在前5年将局部复发率降至最低。在高达四分之一的局部复发病例中，局部复发的疾病将是一个决定因素，而不仅仅是远处复发和死亡风险的一个标志。两种类型的局部复发都是相同生物学过程的表现，反映了肿瘤的内在行为。这一原则适用于通过辅助放疗和手术方式降低局部复发率。
