Kuske R R, Farr G H, Harris K, Bolton J S, Sardi A, McKinnon W H, Kardinal C G, Cole J, Pickett T K, Graham M L
Ochsner Center for Radiation Oncology, New Orleans.
J La State Med Soc. 1993 Apr;145(4):165-7.
Breast conservation therapy is an accepted treatment option for early stage breast carcinoma, but is rarely considered appropriate for locally advanced nonmetastatic lesions. Mastectomy specimens of 46/50 patients treated at the Ochsner Clinic and the Mallinckrodt Institute of Radiology with neoadjuvant chemotherapy prior to mastectomy +/- irradiation were evaluated by a single pathologist to assess tumor response to chemotherapy. Forty percent of this group would potentially have been eligible for breast conservation therapy, using a residual tumor size of < or = 4 cm with negative surgical margins as the criteria. Patients most likely to qualify for breast conservation therapy were those with T3N0-1 lesions (67%). Least likely were patients with skin involvement at diagnosis 4/33 (12%). Tumors with an extensive intraductal component at biopsy often had residual islands of intraductal carcinoma occupying the original tumor volume, even when the invasive component was absent or much reduced. A prospective trial will be required to determine whether or not acceptable local control rates can be obtained after breast conservation therapy for that subset of patients with a favorable response to induction chemotherapy.
保乳治疗是早期乳腺癌公认的治疗选择，但很少被认为适用于局部晚期非转移性病变。对在奥施纳诊所和马林克罗特放射研究所接受乳房切除术±放疗前新辅助化疗的50例患者中的46例乳房切除标本，由一名病理学家进行评估，以评估肿瘤对化疗的反应。以残留肿瘤大小≤4 cm且手术切缘阴性为标准，该组中40%的患者可能符合保乳治疗条件。最有可能符合保乳治疗条件的患者是T3N0-1病变患者（67%）。最不可能符合条件的是诊断时有皮肤受累的患者，4/33（12%）。活检时具有广泛导管内成分的肿瘤，即使浸润成分不存在或大量减少，通常仍有导管内癌残留岛占据原始肿瘤体积。需要进行一项前瞻性试验，以确定对诱导化疗反应良好的那部分患者在保乳治疗后是否能获得可接受的局部控制率。
