Hughes K S, Lee A K, Rolfs A
Lahey-Hitchcock Breast Cancer Treatment Center, Burlington, MA 01805, USA
Surg Clin North Am. 1996 Apr;76(2):243-65. doi: 10.1016/s0039-6109(05)70437-0.
In summary, certain subgroups of DCIS appear not to require radiation. Corroboration of these results from retrospective reviews and prospective trials is necessary to confirm the safety and efficacy of individualized treatment strategies. Even though the current standard of treatment is (1) lumpectomy with radiation therapy, (2) mastectomy, or (3) mastectomy with reconstruction, it is possible in the future to say that patients with low-grade DCIS (the exact criteria to be defined) may be eligible for breast conservation without radiation, and all patients with high-grade DCIS or perhaps low-grade DCIS with necrosis would be treated best by lumpectomy plus radiation. It is possible that a small subgroup of patients may be best treated by mastectomy, or perhaps, as the results of B-24 become available, by radiation therapy plus tamoxifen. The use of tumor markers such as c-erbB-2, cathepsin D, and NM 23 may help us to better define these subgroups, but much study is necessary before a definite treatment strategy is reached.
总之，某些导管原位癌（DCIS）亚组似乎不需要放疗。需要回顾性研究和前瞻性试验对这些结果进行确证，以证实个体化治疗策略的安全性和有效性。尽管目前的治疗标准是（1）保乳手术加放疗，（2）乳房切除术，或（3）乳房切除术后重建，但未来有可能说，低级别DCIS患者（确切标准有待确定）可能有资格接受不保乳的乳房保留治疗，而所有高级别DCIS患者或可能伴有坏死的低级别DCIS患者最好采用保乳手术加放疗。可能有一小部分患者最好采用乳房切除术治疗，或者随着B-24试验结果的公布，或许采用放疗加他莫昔芬治疗。使用肿瘤标志物如c-erbB-2、组织蛋白酶D和NM 23可能有助于我们更好地界定这些亚组，但在得出明确的治疗策略之前，还需要进行大量研究。
