Read Rebecca L, Flitcroft Kathy, Snook Kylie L, Boyle Frances M, Spillane Andrew J
Breast and Surgical Oncology, Poche Centre, North Sydney, New South Wales, Australia; Department of Surgery, Royal North Shore Hospital, St Leonards, New South Wales, Australia.
ANZ J Surg. 2015 May;85(5):315-20. doi: 10.1111/ans.12975. Epub 2015 Jan 22.
Neoadjuvant chemotherapy (NAC) is a legitimate alternative to first-line surgical therapy for the treatment of breast cancer patients, as level one evidence shows the effect on overall survival is equivalent to that of adjuvant chemotherapy. In the treatment of women with operable breast cancer, NAC provides a number of potential advantages including: improving the chance of achieving breast-conserving surgery, improving cosmesis after breast-conserving surgery, downstaging the breast and axilla, allowing time to fully consider surgical options, time for genetic testing and facilitating breast reconstruction in otherwise high-risk patients. However, in Australia, NAC is poorly utilized with less than 3% of women with operable breast cancer receiving NAC. This review discusses the potential harms and benefits of NAC, discusses areas of controversy in the use of NAC and describes how we have used NAC in our own practice. We conclude that if it is obviously necessary for the newly presenting breast cancer patient to have chemotherapy as part of the treatment, it is worth considering NAC. In many patients, the potential benefits of NAC outweigh the harms. However, maximizing these benefits is closely aligned with appropriate patient selection and timely multidisciplinary team communication.
新辅助化疗（NAC）是治疗乳腺癌患者一线手术治疗的合理替代方案，因为一级证据表明其对总生存期的影响与辅助化疗相当。在可手术乳腺癌女性的治疗中，NAC具有诸多潜在优势，包括：提高保乳手术的成功率、改善保乳手术后的美容效果、降低乳房和腋窝分期、有时间充分考虑手术方案、进行基因检测的时间以及便于在其他高危患者中进行乳房重建。然而，在澳大利亚，NAC的使用率很低，可手术乳腺癌女性中接受NAC的不到3%。本综述讨论了NAC的潜在危害和益处，讨论了NAC使用中的争议领域，并描述了我们在自己的实践中如何使用NAC。我们得出结论，如果新诊断的乳腺癌患者显然需要进行化疗作为治疗的一部分，那么值得考虑NAC。在许多患者中，NAC的潜在益处超过危害。然而，最大化这些益处与适当的患者选择和及时的多学科团队沟通密切相关。
