Kuerer Henry M, Smith Benjamin D, Chavez-MacGregor Mariana, Albarracin Constance, Barcenas Carlos H, Santiago Lumarie, Edgerton Mary E, Rauch Gaiane M, Giordano Sharon H, Sahin Aysegul, Krishnamurthy Savitri, Woodward Wendy, Tripathy Debasish, Yang Wei T, Hunt Kelly K
Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX.
Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX.
J Cancer. 2017 Aug 22;8(14):2653-2662. doi: 10.7150/jca.20871. eCollection 2017.
Recent published guidelines suggest that adequate margins for DCIS should be ≥ 2 mm after breast conserving surgery followed by radiotherapy (RT). Many groups now use this guideline as an absolute indication for additional surgery. This article describes detailed multidisciplinary practices including extensive preoperative/intraoperative pathologic/histologic image-guided assessment of margins, offering some patients with small low/intermediate grade DCIS no RT, the use/magnitude of radiation boost tailoring to margin width, and endocrine therapy for ER-positive DCIS. Use of these protocols over the past 20-years has resulted in 10-year local recurrence rates below 5% for patients with negative margins < 2 mm who received RT. Patients with margins < 2 mm who do not receive RT experience significantly higher local failure rates. Thus, there is not an absolute need to achieve wider negative surgical margins when < 2 mm for patients treated with RT and this should be determined by the multidisciplinary team. Utilization of these multidisciplinary treatment protocols and techniques may not be exportable and extrapolated to all hospitals, breast programs and systems as they can be complex and resource intensive.
最近发布的指南建议，保乳手术联合放疗（RT）后，导管原位癌（DCIS）的切缘宽度应≥2mm。现在许多团队将该指南作为再次手术的绝对指征。本文描述了详细的多学科治疗方法，包括术前/术中对切缘进行广泛的病理/组织学图像引导评估，为一些低/中级别小灶DCIS患者不进行放疗，根据切缘宽度调整放疗增敏的使用/剂量，以及对雌激素受体（ER）阳性DCIS进行内分泌治疗。在过去20年中，对于切缘阴性且宽度<2mm并接受放疗的患者，采用这些方案后10年局部复发率低于5%。切缘宽度<2mm且未接受放疗的患者局部失败率显著更高。因此，对于接受放疗的患者，切缘宽度<2mm时并非绝对需要获得更宽的阴性手术切缘，这应由多学科团队来决定。这些多学科治疗方案和技术的应用可能无法推广至所有医院、乳腺治疗项目和医疗体系，因为它们可能复杂且资源密集。
