Kliniken Essen Mitte, Klinik für Senologie, Essen, Germany.
Br J Surg. 2014 Jul;101(8):912-24. doi: 10.1002/bjs.9545. Epub 2014 May 19.
Neoadjuvant chemotherapy (NACT) is a standard treatment option for primary operable breast cancer when adjuvant chemotherapy is indicated.
This article reviews the use of NACT in breast cancer treatment.
Pathological complete response (pCR) rates of up to 60 per cent have been reached for certain breast cancer subgroups. Patients achieving a pCR have a lower locoregional recurrence rate. Nevertheless, the rate of breast-conserving surgery seems to be stable at around 65-70 per cent, although more than 80 per cent of patients respond to NACT. The risk of local relapse does not appear to be higher after NACT, which supports the recommendation to operate within the new margins, as long as there is no tumour in the inked area of the surgical specimen. However, tumours do not shrink concentrically and the re-excision rate is higher after NACT. Mastectomy rates for lobular carcinomas remain high irrespective of tumour response. The role of sentinel lymph node biopsy (SLNB) in the context of NACT has been studied in recent years, and it is not yet completely clear which type of axillary staging is the most suitable. SLNB before NACT in clinically node-negative patients has been the preferred option. However, this practice is currently changing, and it seems advisable to have the SLNB after NACT to reduce the risk of a false-negative SLNB.
Overall, patients do benefit from NACT, especially those with human epidermal growth factor receptor 2-positive and triple-negative breast cancer, but surgical/local procedures need to be adapted.
新辅助化疗（NACT）是有辅助化疗指征的原发性可手术乳腺癌的标准治疗选择。
本文综述了 NACT 在乳腺癌治疗中的应用。
某些乳腺癌亚组的病理完全缓解（pCR）率达到了 60%。达到 pCR 的患者局部区域复发率较低。然而，保乳手术率似乎稳定在 65-70%左右，尽管超过 80%的患者对 NACT 有反应。NACT 后局部复发的风险似乎并没有增加，这支持了在新切缘范围内进行手术的建议，只要在手术标本的墨渍区域没有肿瘤即可。然而，肿瘤不会同心缩小，NACT 后再次切除的比例更高。无论肿瘤反应如何，乳腺小叶癌的乳房切除术率仍然很高。近年来，人们研究了新辅助化疗背景下前哨淋巴结活检（SLNB）的作用，哪种腋窝分期方式最适合仍不完全清楚。在临床淋巴结阴性的患者中，在 NACT 之前进行 SLNB 一直是首选。然而，目前这种做法正在发生变化，似乎在 NACT 后进行 SLNB 更为明智，以降低 SLNB 假阴性的风险。
总体而言，NACT 使患者受益，尤其是人表皮生长因子受体 2 阳性和三阴性乳腺癌患者，但需要调整手术/局部治疗方法。
