Bartelink H
The Netherlands Cancer Institute, Antoni van Leeuwenhoekhuis, Amsterdam.
Eur J Cancer Clin Oncol. 1988 Jan;24(1):77-82. doi: 10.1016/0277-5379(88)90180-0.
Breast conserving therapy with adequate radiotherapy results in similar local control and survival in patients with early breast cancer. Radiotherapy has proven to be an integral part of this treatment as in the NSABP trial a significant reduction of breast recurrences occurred after irradiation, compared with tumorectomy alone. The entry criteria of the performed randomized trials were initially limited to patients with tumours up to 2 cm diameter, but even patients with incompletely excised tumours up to 5 cm have been accepted in the recently closed EORTC trial 10801. This means that this conservative approach is now accessible for a much larger group of patients with breast cancer. A few factors related to a somewhat higher recurrence rate in the breast are: extensive ductal carcinoma in situ, younger age and incomplete excision. These factors are, however, not absolute contra-indications for breast conserving therapy because wide reexcision of the primary tumour or a high booster dose are likely to correct for these unfavourable factors. Future clinical research is required to optimize the irradiation with reduction of side-effects and maintaining a high local control rate.
早期乳腺癌患者采用适当放疗的保乳治疗，其局部控制率和生存率相似。放疗已被证明是这种治疗不可或缺的一部分，因为在NSABP试验中，与单纯肿瘤切除术相比，放疗后乳腺复发显著减少。已开展的随机试验的入选标准最初仅限于肿瘤直径达2厘米的患者，但在最近结束的EORTC试验10801中，肿瘤直径达5厘米且切除不完全的患者也被纳入。这意味着现在更多乳腺癌患者可以采用这种保守治疗方法。与乳腺复发率略高相关的一些因素包括：广泛导管原位癌、年轻以及切除不完全。然而，这些因素并非保乳治疗的绝对禁忌证，因为对原发肿瘤进行广泛再次切除或给予高剂量增强放疗可能会纠正这些不利因素。未来需要开展临床研究，以优化放疗，减少副作用并维持较高的局部控制率。
