Division of Medical Oncology and Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada.
Breast Health Center, St. Francis Hospital, Vienna, Austria; Austrian Breast and Colorectal Cancer Study Group, Vienna, Austria.
Breast. 2023 Oct;71:132-137. doi: 10.1016/j.breast.2023.08.006. Epub 2023 Aug 22.
Treatment for early-stage breast cancer is complex, requiring multidisciplinary care with a multitude of treatment options available for each patient. Coupled with the rising importance of shared decision-making, patient-physician conversations are progressively more complicated. These conversations require frank disclosure of risks and benefits of the different treatment modalities in a way that is individualized for each patient and simple to understand. In most patients, breast conserving therapy with radiation should be presented as the gold-standard local treatment given similar long-term and improved quality of life outcomes. De-escalation is currently at the forefront of research in loco-regional treatments, and further investigations are required to best determine the optimal patient populations for reduced sentinel lymph node sampling, omission of sentinel lymph node biopsy altogether and omission of radiation treatment. For future trials, better endpoints need to be established considering patient-centered outcomes as well as recurrence.
早期乳腺癌的治疗较为复杂，需要多学科的综合治疗，每个患者都有多种治疗方案可供选择。再加上共同决策的重要性不断上升，医患之间的对话变得越来越复杂。这些对话需要以个体化和易于理解的方式，坦率地向患者披露不同治疗方式的风险和获益。在大多数患者中，保乳联合放疗应作为标准的局部治疗方法，因为其长期疗效和改善生活质量的效果相似。局部治疗的降级治疗目前是研究的前沿领域，需要进一步的研究来确定最佳的患者人群，以减少前哨淋巴结采样、完全省略前哨淋巴结活检以及省略放射治疗。对于未来的临床试验，需要建立更好的终点，既要考虑以患者为中心的结果，也要考虑复发的情况。
