Department of Medical Oncology, Chris O'Brien Lifehouse, Camperdown, New South Wales, Australia; Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia.
Department of Medical Oncology, Chris O'Brien Lifehouse, Camperdown, New South Wales, Australia; Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia.
Crit Rev Oncol Hematol. 2019 Feb;134:10-21. doi: 10.1016/j.critrevonc.2018.11.007. Epub 2018 Nov 30.
Modern breast cancer care is a complex multidisciplinary undertaking in which the integrated function of multiple constituent parts is critical, and where changes to one therapeutic component may profoundly influence the delivery and outcomes of another. Oncoplastic and reconstructive breast surgery has evolved in the era of longer survival rates for women with breast cancer and aims to enhance oncological and cosmetic outcomes. However, concurrently there has been an expansion in the indications for post-mastectomy radiation therapy (Abdulkarim et al., 2011; Early Breast Cancer Trialists' Collaborative Group (EBCTCG), 2014; Poortmans et al., 2015; Wang et al., 2011), the recognition of several biologically distinct breast cancer subtypes (Perou et al., 2000; Sørlie et al., 2001, 2003; Cheang et al., 2008, 2009; Sotiriou et al., 2003; Millar et al., 2011; Blows et al., 2010; Schnitt, 2010; Haque et al., 2012; Dai et al., 2015) and the development of recommendations for prophylactic surgery for high-risk women, including BRCA-mutation carriers (James et al., 2006; Domchek et al., 2010). Primary systemic therapy is increasingly utilised yet has varying efficacy depending on tumour biology (Cortazar et al., 2014). In this paper we review the evidence which informs the multidisciplinary team opinion in the era of oncoplastic and reconstructive breast surgery. We aim to describe an optimal multidisciplinary approach which balances competing risks of multimodal therapies to optimise oncological and cosmetic outcomes.
现代乳腺癌治疗是一项复杂的多学科工作，其中多个组成部分的综合功能至关重要，治疗组成部分的变化可能会深刻影响另一个治疗组成部分的实施和结果。肿瘤整形和重建乳房手术是在乳腺癌患者生存率提高的时代发展起来的，旨在提高肿瘤学和美容学的效果。然而，同期乳房切除术放疗的适应证也在扩大（Abdulkarim 等人，2011 年；早期乳腺癌试验者协作组（EBCTCG），2014 年；Poortmans 等人，2015 年；Wang 等人，2011 年），认识到几种生物学上不同的乳腺癌亚型（Perou 等人，2000 年；Sørlie 等人，2001 年，2003 年；Cheang 等人，2008 年，2009 年；Sotiriou 等人，2003 年；Millar 等人，2011 年；Blows 等人，2010 年；Schnitt，2010 年；Haque 等人，2012 年；Dai 等人，2015 年），并为高风险女性制定了预防性手术的建议，包括 BRCA 基因突变携带者（James 等人，2006 年；Domchek 等人，2010 年）。新辅助全身治疗越来越多地被应用，但根据肿瘤生物学的不同，其疗效也有所不同（Cortazar 等人，2014 年）。在本文中，我们回顾了在肿瘤整形和重建乳房手术时代为多学科团队提供意见的证据。我们旨在描述一种最佳的多学科方法，平衡多种治疗方法的竞争风险，以优化肿瘤学和美容学的效果。
