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新辅助化疗是局部晚期乳腺癌标准治疗方案中的重要组成部分之一,可提高肿瘤切除率与保乳率。对于早期乳腺癌,新辅助化疗可使原发肿瘤降期以提高局部切除的可行性,并可早期评价化疗敏感性从而指导个体化治疗。一些研究已经证实新辅助化疗的反应与患者生存率相关,许多患者将得益于其对远处器官内微小转移灶的控制。本文将就新辅助化疗后保乳的选择、乳房再造术的时机以及区域淋巴结治疗等局部病灶外科处理的研究进展作一综述。1)新辅助化疗后的保乳手术不应为追求保乳而以降低生存率或增加局部复发为代价,且选择标准应与直接手术相一致,存在局部晚期病变但对化疗反应好的患者也考虑保乳手术。2)新辅助化疗后的晚期乳腺癌患者行即刻乳房再造术,其并发症发生率并无增加;但放疗可导致假体再造乳房的包膜挛缩或反复感染,对自体乳房再造的影响尚无定论,因此局部晚期乳腺癌患者应考虑行延迟乳房再造术;Kronowitz等人提出的“延迟-即刻”乳房再造是一种具有实用价值的方法。3)对新辅助化疗敏感的患者可考虑通过前哨淋巴结活检进行腋窝淋巴结分期;在新辅助化疗前后行活检各有利弊,一些研究中将超声和前哨淋巴结活检相结合来判断腋窝淋巴结状态的方法值得借鉴,但尚需更多的研究加以证实。
Neoadjuvant chemotherapy is an important part of the standard treatment of locally advanced breast cancer, which can improve the rate of tumor resection and breast-conserving rate. For early breast cancer, neoadjuvant chemotherapy can be the primary tumor down to enhance the feasibility of local resection, and early evaluation of chemosensitivity to guide the individualized treatment. Several studies have demonstrated that the response to neoadjuvant chemotherapy is associated with patient survival, and many patients will benefit from their control of micrometastases in distant organs. This article reviews the progress of researches on the surgical treatment of local lesions such as the choice of breast-conserving after neoadjuvant chemotherapy, the timing of breast reconstruction and regional lymph node therapy. 1) Neoadjuvant chemotherapy after breast-conserving surgery should not be the pursuit of breast-conserving and to reduce the survival rate or increase the cost of local recurrence, and the selection criteria should be consistent with direct surgery, there are locally advanced lesions, but good response to chemotherapy patients Consider breast-conserving surgery. 2) The patients with advanced breast cancer after neoadjuvant chemotherapy underwent immediate breast reconstruction with no increase in the complication rate; however, radiotherapy can cause capsular contracture or recurrent infection in the reconstructed breast, which has no effect on self-reconstruction Therefore, patients with locally advanced breast cancer should consider delayed mammography. Kronowitz et al.’s proposed “delayed-immediate” breast reconstruction is a valuable method. 3) Patients who are sensitive to neoadjuvant chemotherapy may consider axillary lymph node staging by sentinel lymph node biopsy. There are pros and cons of biopsy before and after neoadjuvant chemotherapy. In some studies, the combination of ultrasound and sentinel lymph node biopsy to determine axillary lymph node status is worthy Learn, but still need more research to confirm.