Schnitt S J
Department of Pathology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts 02215, USA.
Mod Pathol. 1998 Feb;11(2):129-33.
The results of prospective randomized clinical trials demonstrated that the combination of conservative surgery and radiation therapy produced survival rates equivalent to those obtained with mastectomy for patients with Stage I and II invasive breast cancer. The identification, however, of a subset of patients who can be safely spared radiation therapy after breast-conserving surgery is an important goal. Randomized trials comparing conservative surgery alone with conservative surgery and radiation therapy consistently demonstrated a large reduction in the risk of local recurrence with the addition of radiation. Although no significant differences in survival were observed between these two groups, the available studies cannot exclude the possibility of a small survival advantage for patients treated with radiation therapy. Analyses of patient subsets within the randomized trials and within other prospective and retrospective studies failed to identify with consistence a subgroup of patients who did not benefit from radiation therapy. At present, radiation therapy should remain a part of breast-conserving treatment for patients with invasive breast cancer.
前瞻性随机临床试验结果表明，对于I期和II期浸润性乳腺癌患者，保乳手术与放射治疗联合应用的生存率与乳房切除术相当。然而，确定保乳手术后可安全避免放射治疗的患者亚组是一个重要目标。比较单纯保乳手术与保乳手术加放射治疗的随机试验一致表明，加用放射治疗可大幅降低局部复发风险。虽然两组之间未观察到生存率有显著差异，但现有研究不能排除放射治疗患者存在微小生存优势的可能性。对随机试验以及其他前瞻性和回顾性研究中的患者亚组分析未能一致确定未从放射治疗中获益的患者亚组。目前，放射治疗仍应作为浸润性乳腺癌患者保乳治疗的一部分。
