Department of Surgical Oncology, Catharina Ziekenhuis Eindhoven, Eindhoven, The Netherlands.
Department of Radiation Oncology, Catharina Ziekenhuis Eindhoven, Eindhoven, The Netherlands.
Breast Cancer Res Treat. 2021 Jun;187(2):499-514. doi: 10.1007/s10549-021-06154-2. Epub 2021 Mar 13.
In line with the paradigm to minimize surgical morbidity in patients with primary breast cancer, there is increasing evidence for the safety of a repeat breast-conserving treatment (BCT) of an ipsilateral breast tumour recurrence (IBTR) in selected patients. The conditions for the feasibility of a repeat BCT vary widely in literature. In clinical practice, many physicians have ongoing concerns about the oncological safety and possible toxicity of repeat BCT.
To investigate the attitude of Dutch breast surgeons and radiation oncologists towards repeat BCT and to report on their experiences with, objections against and perceived requirements to consider a repeat BCT in case of IBTR.
An online survey consisting of a maximum of 26 open and multiple-choice questions about repeat BCT for IBTR was distributed amongst Dutch breast surgeons and radiation oncologists.
Forty-nine surgeons representing 49% of Dutch hospitals and 20 radiation oncologists representing 70% of Dutch radiation oncology centres responded. A repeat BCT was considered feasible in selected cases by 28.7% of breast surgeons and 55% of radiation oncologists. The most important factors to consider a repeat BCT for both groups were the patient's preference to preserve the breast and surgical feasibility of a second lumpectomy. Arguments against a repeat BCT were based on the perceived unacceptable toxicity and cosmesis of a second course of radiotherapy. The technique of preference for re-irradiation would be partial breast irradiation (PBI) according to all radiation oncologists. Differentiating between new primary tumours (NPT) and true recurrences (TR) was reported to be done by 57.1% of breast surgeons and 60% of radiation oncologists. The most important reason to differentiate between NPT and TR was to establish prognosis and to consider whether a repeat BCT would be feasible.
An increasing number of Dutch breast cancer specialists is considering a repeat BCT feasible in selected cases, at the patient's preference and with partial breast re-irradiation.
为了尽量减少原发性乳腺癌患者的手术发病率，越来越多的证据表明，在选择的患者中，重复保乳治疗（BCT）同侧乳房肿瘤复发（IBTR）是安全的。文献中对重复 BCT 的可行性条件差异很大。在临床实践中，许多医生对重复 BCT 的肿瘤安全性和可能的毒性仍存在担忧。
调查荷兰乳腺外科医生和放射肿瘤学家对重复 BCT 的态度，并报告他们在 IBTR 情况下对重复 BCT 的经验、反对意见和认为需要考虑的因素。
向荷兰乳腺外科医生和放射肿瘤学家分发了一份关于重复 BCT 治疗 IBTR 的在线调查，其中包括最多 26 个关于重复 BCT 的开放性和多项选择题。
49 名代表荷兰 49%医院的外科医生和 20 名代表荷兰 70%放射肿瘤学中心的放射肿瘤学家做出了回应。28.7%的乳腺外科医生和 55%的放射肿瘤学家认为在某些情况下可以进行重复 BCT。两组最重要的考虑因素是患者对保留乳房的偏好和第二次肿块切除术的手术可行性。反对重复 BCT 的论据是基于第二次放疗的毒性和美容效果不可接受。所有放射肿瘤学家都认为首选的再放疗技术是部分乳房照射（PBI）。57.1%的乳腺外科医生和 60%的放射肿瘤学家报告说，他们将区分新原发性肿瘤（NPT）和真正的复发（TR）。区分 NPT 和 TR 的最重要原因是确定预后，并考虑是否可行重复 BCT。
越来越多的荷兰乳腺癌专家认为，在患者的偏好和部分乳房再放疗的情况下，重复 BCT 在某些情况下是可行的。
