McCormick B
Memorial Sloan-Kettering Cancer Center, New York, New York 10021.
Cancer. 1994 Jul 1;74(1 Suppl):430-5. doi: 10.1002/cncr.2820741331.
Selection criteria applicable to women desiring breast-conserving surgery and radiation for early invasive breast cancer have evolved over the last decade. The presence of active collagen vascular disease has emerged as a contraindication for this treatment. The roles of both young and old age have been debated by many authors, although a growing body of literature supports the impact of age on both local control and disease free survival.
This is a review of the literature addressing these selection criteria.
A consensus exists regarding the impact of preexisting collagen vascular disease on the anticipated complications with breast-conserving radiation, despite small numbers reported. A young age, although not always a statistically significant factor, emerges as a consistent predictor for both local and distant failures. This is true not only for patients who opt for breast conservation but also those who are treated with mastectomy. To the contrary, preliminary data suggests that older age is emerging as a predictor for improved local and regional control.
Preexisting collagen vascular disease is a contraindication for the use of breast-conserving radiation and surgery. Extremes of age must be considered in terms of recommending not so much a specific local regional treatment, but an overall strategy. For the very young patient with breast cancer, more aggressive systemic therapy should be considered in addition to the appropriate local regional therapy. For the elderly, preliminary pilot studies suggest that tamoxifen may play a role in local as well systemic control, perhaps opening the door for future trials examining the need for radiation in selected elderly patients.
在过去十年中，适用于希望通过保乳手术和放疗治疗早期浸润性乳腺癌的女性的选择标准不断演变。活动性胶原血管疾病已成为这种治疗的禁忌症。许多作者都对年轻和年老的作用进行了辩论，尽管越来越多的文献支持年龄对局部控制和无病生存的影响。
这是一篇关于这些选择标准的文献综述。
尽管报道的病例数量较少，但对于既往胶原血管疾病对保乳放疗预期并发症的影响已达成共识。年轻，虽然并非总是一个具有统计学意义的因素，但却是局部和远处复发的一致预测指标。这不仅适用于选择保乳的患者，也适用于接受乳房切除术的患者。相反，初步数据表明，年龄较大正成为局部和区域控制改善的预测指标。
既往胶原血管疾病是使用保乳放疗和手术的禁忌症。在推荐治疗方案时，必须考虑年龄因素，这与其说是为了推荐一种特定的局部区域治疗方法，不如说是为了制定一个整体策略。对于非常年轻的乳腺癌患者，除了适当的局部区域治疗外，还应考虑更积极的全身治疗。对于老年人，初步的试点研究表明，他莫昔芬可能在局部和全身控制中发挥作用，这可能为未来研究特定老年患者是否需要放疗的试验打开大门。
