Gynaecological Oncology, Candiolo Cancer Institute, FPO - IRCCS, Italy.
Eur J Surg Oncol. 2020 Aug;46(8):1551-1553. doi: 10.1016/j.ejso.2020.05.005. Epub 2020 May 11.
Several population-based studies suggest that breast conserving surgery followed by radiotherapy (BCT) may provide longer overall survival than mastectomy. Better locoregional control after BCT due to improvements of preoperative imaging, oncoplastic surgery and radiotherapy, as well as the recent trend towards surgical de-escalation may be involved. Alternatively, modern radiotherapy may have such an improved benefit/risk ratio that its survival advantage now stands out more clearly. However, since the therapeutic equivalence of BCT and mastectomy was demonstrated by several randomised trials, this information cannot be disregarded, nor radiotherapy should be used to compensate for inadequate surgery. Both BCT and mastectomy are likely here to stay as clinical presentation of breast cancer is highly variable, and women desires may transcend a rational balance of pros and cons between the two surgical approaches. Our duty as surgeons is to lead the multidisciplinary board and accompany the patients along this difficult decision-making process.
几项基于人群的研究表明，保乳手术联合放疗（BCT）可能比乳房切除术提供更长的总生存期。由于术前影像学、肿瘤整形手术和放疗的改进，以及最近向手术降级的趋势，BCT 后的局部区域控制更好。或者，现代放疗可能具有更好的获益/风险比，其生存优势现在更加明显。然而，由于几项随机试验已经证明了 BCT 和乳房切除术的治疗等效性，因此不能忽视这一信息，也不应该使用放疗来弥补手术的不足。BCT 和乳房切除术都可能继续存在，因为乳腺癌的临床表现高度可变，并且女性的愿望可能超越两种手术方法之间利弊的理性平衡。作为外科医生，我们的职责是领导多学科委员会，并在这个艰难的决策过程中陪伴患者。
