Hermann R E, Esselstyn C B, Grundfest-Broniatowski S, Steiger E, Vogt D P, Broughan T A, Dowden R V, Hardesty I, Medendorp S V, Boyett J M
Department of General Surgery, Cleveland Clinic Foundation, Ohio 44106.
Surg Gynecol Obstet. 1993 Sep;177(3):247-53.
The treatment of potentially curable carcinoma of the breast has changed from one operation, radical mastectomy, to a flexible approach. At the Cleveland Clinic, we use four types of treatment for primary potentially curable carcinoma of the breast (Stages 0, I and II)--modified radical mastectomy, simple mastectomy, partial mastectomy with postoperative adjuvant radiation therapy and partial mastectomy without radiation therapy. The latter treatment (partial mastectomy without adjuvant radiation) is controversial. We recommend this procedure for patients with T(is) and T1 carcinomas that appear to be localized, without lymph node metastases, Stages 0 and I disease. The overall and disease-free survival rates are similar to those of patients having modified radical or partial mastectomy with radiation. Local recurrence is slightly higher at five years (11.0 percent) as compared with the other procedures, but at ten years, is only 16.1 percent, a figure comparable with patients having partial mastectomy with radiation (14.4 percent). For patients with Stages 0 and I carcinoma of the breast, the addition of postoperative radiation therapy after partial mastectomy seems to be unnecessary.
乳腺癌潜在可治愈性癌的治疗方法已从单一手术——根治性乳房切除术,转变为一种灵活的治疗方式。在克利夫兰诊所,我们对原发性乳腺癌潜在可治愈性癌(0期、Ⅰ期和Ⅱ期)采用四种治疗方法——改良根治性乳房切除术、单纯乳房切除术、保乳术后辅助放疗和保乳不放疗。后一种治疗方法(保乳不放疗)存在争议。对于Tis期和T1期、看似局限、无淋巴结转移、0期和Ⅰ期疾病的患者,我们推荐这种手术方式。其总生存率和无病生存率与接受改良根治性乳房切除术或保乳放疗的患者相似。与其他手术相比,五年时局部复发率略高(11.0%),但十年时仅为16.1%,这一数字与保乳放疗患者(14.4%)相当。对于0期和Ⅰ期乳腺癌患者,保乳术后似乎无需加用术后放疗。