Nixon A J, Troyan S L, Harris J R
The Joint Center for Radiation Therapy, Beth Isreal Hospital, Harvard Medical School, Boston, Massachusetts, USA.
Semin Oncol. 1996 Aug;23(4):453-63.
Newly diagnosed, early-stage breast cancer confronts the patient and her clinician with multiple treatment decisions. This review examines some of these local treatment options including the choice between breast-conserving treatment (BCT) and mastectomy, how best to treat the axilla, and the optimal sequencing of local and systemic therapy. Key elements in the selection of patients for BCT or mastectomy include preoperative mammography, careful pathological evaluation, and an assessment of patient desires in order to balance the risk of local recurrence against preservation of a cosmetically acceptable breast. Although some absolute contraindications to BCT exist, most patients are candidates for BCT. The role of axillary dissection is currently being redefined, and in the future, more limited procedures may be able to identify patients who can avoid axillary dissection. The relationship between timing of breast surgery with regard to the menstrual cycle and outcome is intriguing but not yet established. As well, the appropriate sequencing of chemotherapy and radiotherapy (RT) after conservative surgery (CS) is uncertain, although randomized trials are beginning to shed some light on this issue. Whether all patients treated with CS require treatment with RT is another question that is currently under investigation. This article addresses these issues, focusing on the specifics of treatment implementation.
新诊断出的早期乳腺癌使患者及其临床医生面临多种治疗决策。本综述探讨了其中一些局部治疗选择，包括保乳治疗（BCT）和乳房切除术之间的选择、腋窝的最佳治疗方法以及局部和全身治疗的最佳顺序。选择BCT或乳房切除术患者的关键因素包括术前乳房X线摄影、仔细的病理评估以及对患者意愿的评估，以便在局部复发风险与保留外观可接受的乳房之间取得平衡。虽然BCT存在一些绝对禁忌证，但大多数患者是BCT的候选者。腋窝清扫术的作用目前正在重新定义，未来，更有限的手术可能能够识别出可以避免腋窝清扫术的患者。乳房手术时间与月经周期之间的关系及其结果很有趣，但尚未确定。同样，保守手术（CS）后化疗和放疗（RT）的适当顺序尚不确定，尽管随机试验开始对此问题有所揭示。是否所有接受CS治疗的患者都需要接受RT治疗是另一个目前正在研究的问题。本文讨论了这些问题，重点关注治疗实施的具体细节。
