乳腺癌治疗方法的革新与挑战

The challenges after innovations in breast cancer therapy

随着乳腺癌治疗方法研究的进展与新方法的应用,发现了不少受学者们关注的问题,对肿瘤医师,包括乳腺外科医师、放射治疗医师和肿瘤内科医师都提出新的挑战。如因乳腺癌前哨淋巴结活检的准确性差异导致手术方法选择不当造成的后果,法律责任怎样承担的问题;保留乳房切除术后对传统的放射治疗方法带来新的挑战;新辅助化疗使原发肿瘤或/和转移淋巴结中的癌组织坏死,影响对手术切缘癌细胞浸润的判断和腋窝淋巴结转移真实性的判断,以及由此而带来的对放射治疗适应证的评判和放射治疗方法选择的影响;长时间服用三苯氧胺(TAM)等内分泌药物治疗导致子宫内膜增生、甚至癌变。这些都需要人们正确面对和重视,迎接新的挑战,解决新的问题。

With the progress of breast cancer researches, new ideas are constantly brought forth to improve the treatment methods. However, with the application of new methods, the oncologists, including breast surgeons, radiation therapists, and medical oncologists have to face new problems and challenges. For example, the poor accuracy of the sentinel lymph node biopsy for breast cancer may lead to the improper choice of operation method; breast-conserving surgery challenges the postoperative radiotherapy methods; the necrosis of the primary tumor tissue and/or metastatic lymph nodes after neoadjuvant chemotherapy affects the evaluation of the surgical margin status and the truthfulness of the axillary lymph node metastasis, and hence affects the judgment of the radiotherapy indications and the choice of the radiotherapy methods; long-term administration of tamoxifen （TAM） or other endocrine-involved drugs may lead to endometrial hyperplasia, even cancerization. We must take these problems seriously and take challenges actively to solve problems.