Pilch Y H
Postgrad Med. 1983 Sep;74(3):126-9, 132-4. doi: 10.1080/00325481.1983.11698419.
For about three quarters of a century, radical mastectomy was considered standard initial treatment for invasive breast cancer. Within the past 15 years, modified radical mastectomy (total mastectomy with axillary dissection) has replaced radical mastectomy as standard treatment, even though superiority of the former has not been scientifically proven, with the exception of a single study. During the same period, total mastectomy with postoperative irradiation of axillary lymph nodes came into vogue, and debate centered on whether irradiation of nodes was as efficacious as surgical extirpation. Results of several prospective studies indicated that when used prophylactically, neither method enhanced survival but both prevented subsequent nodal disease, and when used therapeutically, both methods controlled cancer growth equally well. Today, modified radical mastectomy is still standard treatment for patients with operable breast cancer, since axillary dissection is now routinely performed for staging purposes, thereby being preferable to irradiation of nodes.
在大约四分之三个世纪里，根治性乳房切除术一直被视为浸润性乳腺癌的标准初始治疗方法。在过去15年中，改良根治性乳房切除术（全乳房切除术加腋窝淋巴结清扫术）已取代根治性乳房切除术成为标准治疗方法，尽管除了一项研究外，前者的优越性尚未得到科学证实。在此期间，全乳房切除术加腋窝淋巴结术后放疗开始流行，争论的焦点在于淋巴结放疗是否与手术切除同样有效。几项前瞻性研究的结果表明，预防性使用时，两种方法都不能提高生存率，但都能预防随后的淋巴结疾病，而治疗性使用时，两种方法控制癌症生长的效果同样良好。如今，改良根治性乳房切除术仍是可手术乳腺癌患者的标准治疗方法，因为现在常规进行腋窝淋巴结清扫以进行分期，因此比淋巴结放疗更可取。
