Noguchi M, Miyazaki I
Operation Center, Kanazawa University Hospital, School of Medicine, Japan.
Int Surg. 1994 Apr-Jun;79(2):142-7.
Breast conserving treatment (BCT) is an alternative to mastectomy, and prospective randomized trials have demonstrated that BCT and radical mastectomy result in similar actuarial survival rates. BCT should fulfil two criteria: (1) it should afford the same local control of disease as radical mastectomy, and (2) it should offer clear cosmetic and psychological advantages. This paper reviews the current status of BCT in the treatment of breast cancer. The choice of a narrow marginal tumor excision with aggressive radiation versus a wide resection with a small dose of radiation is discussed. Although the narrower marginal excisions, such as tumorectomy or lumpectomy provide the best cosmetic results, they may not provide adequate local control even when combined with aggressive irradiation. Wide resections such as quadrantectomy combined with a smaller dose of radiation, results in adequate local control, but less satisfactory cosmetic results. Although body image is better preserved by BCT, a clear enhancement of the psychological well being has yet to be established. Nevertheless, with further improvement in surgical, radiological and chemotherapeutic techniques, BCT likely will be the treatment of choice in more and more patients with operable breast cancer.
保乳治疗（BCT）是乳房切除术的一种替代方案，前瞻性随机试验表明，保乳治疗和根治性乳房切除术的实际生存率相似。保乳治疗应满足两个标准：（1）应能提供与根治性乳房切除术相同的局部疾病控制效果，（2）应具有明显的美容和心理优势。本文综述了保乳治疗在乳腺癌治疗中的现状。讨论了选择窄切缘肿瘤切除加积极放疗与宽切除加小剂量放疗的问题。尽管较窄的切缘切除，如肿瘤切除术或肿块切除术能提供最佳的美容效果，但即使联合积极放疗，也可能无法提供足够的局部控制。宽切除，如象限切除术加较小剂量放疗，能实现足够的局部控制，但美容效果不太理想。尽管保乳治疗能更好地保留身体形象，但心理幸福感是否能明显增强尚未得到证实。然而，随着手术、放射和化疗技术的进一步改进，保乳治疗可能会成为越来越多可手术乳腺癌患者的首选治疗方法。
