乳腺癌局部区域复发的外科和综合诊治策略

Strategies of surgical and comprehensive management of breast cancer patients with local regional recurrence

随着保留乳房手术和前哨淋巴结活检术广泛应用于早期乳腺癌外科治疗,术后局部区域复发的模式发生转变,保留乳房术后乳房肿瘤复发和腋窝淋巴结复发明显增加。由于乳腺癌局部区域复发的发生率低于远处转移、患者既往接受治疗情况不一致、外科手术难度相对较大,前瞻性临床研究少,相关临床诊治面临新的挑战。本文基于乳腺癌局部区域复发理论和临床诊治进展,结合临床实践,提出对于乳腺癌局部区域复发的患者,需在病理明确诊断和系统性评估后,遵循治愈目的,采用包括局部和全身治疗在内的综合治疗模式,以改善患者预后。

Breast conserving surgery and sentinel lymph node biopsy are widely used in early breast cancer treatment. Right now, the mode of local regional recurrence (LRR) has significantly changed and the rate of ipsilateral breast tumor recurrence and axillary lymph node recurrence are steadily increasing. Due to its relatively low incidence of LRR compared with distant metastasis, inconsistent of pre-recurrence treatment, difficulty in surgical treatment, and few prospective clinical studies, there are rising new challenges for clinical management of LRR patients. In this article, based on new theory of LRR, clinical diagnosis and treatment progress, and our own clinical practice experience for LRR breast cancer patients, we propose that we should make pathological diagnosis and do systemic evaluation for LRR disease, then considering it as a curable disease, and integrating local and systemic comprehensive treatment for LRR patients, thus to improve their disease outcome.