Al-Zubeidy Batul H, Weiss Hannah, Khan Seema A
Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
Clin Adv Hematol Oncol. 2018 Sep;16(9):609-618.
The local therapy of breast cancer continues to evolve toward less surgery. Breast conservation is firmly in place, with recent trends toward decreased rates of re-excision. Axillary dissection is becoming a rare operation and is being replaced by sentinel node biopsy. The switch to sentinel node biopsy occurred first in patients with pathologically tumor-free nodes, and later in patients with limited nodal disease. Sentinel node biopsy is now also widely used in patients with pathologically positive nodes who receive neoadjuvant chemotherapy. Axillary surgery is being replaced with radiotherapy in some situations, and ongoing trials will further clarify the need for nodal radiotherapy in specific situations following neoadjuvant systemic therapy. Shorter radiotherapy regimens are widely accepted as the standard of care following breast conservation, and the omission of radiotherapy is recognized as appropriate for older patients. The appropriate sequencing of specific components of local therapy, particularly with regard to the timing of chemotherapy, requires thoughtful multidisciplinary planning and leveraging of the strengths of each component of therapy. Here, we review issues related to therapeutic sequencing and decision making in the local therapy of breast cancer.
乳腺癌的局部治疗正朝着减少手术的方向不断发展。保乳治疗已稳固确立，近期再切除率呈下降趋势。腋窝清扫术正变得罕见，并逐渐被前哨淋巴结活检所取代。前哨淋巴结活检首先应用于病理检查无淋巴结转移的患者，随后也应用于淋巴结转移局限的患者。目前，前哨淋巴结活检也广泛应用于接受新辅助化疗且病理检查淋巴结阳性的患者。在某些情况下，腋窝手术正被放疗所取代，正在进行的试验将进一步明确新辅助全身治疗后特定情况下淋巴结放疗的必要性。较短疗程的放疗方案已被广泛接受为保乳治疗后的标准治疗方法，对于老年患者，省略放疗也被认为是合适的。局部治疗特定组成部分的合理排序，尤其是化疗的时机，需要经过深思熟虑的多学科规划，并充分发挥每种治疗方法的优势。在此，我们回顾乳腺癌局部治疗中与治疗顺序和决策相关的问题。
