保留乳头乳晕复合体的乳腺癌切除术中放疗的地位探讨

The role of radiotherapy in nipple-areola complex-sparing mastectomy for patients with breast cance

在乳腺癌切除术的术式选择中,保留乳头乳晕复合体(nipple-areola complex,NAC)的乳房切除术(nipple-areola complex-sparing mastectomy,NSM)保留了皮肤和NAC,从而有利于后期的重建。目前在NSM治疗中,有几个关键问题尚未达成统一共识,包括NSM术中或术后是否加用或联合局部放疗,最终指向保留NAC后的肿瘤复发的安全性即术后局部复发率问题。有研究报道,不管是术后放疗还是术中放疗,联合NSM都能降低局部复发率,然而,对比联合放疗的研究和未放疗的研究,显示NSM后局部复发率相似,因此从整个NSM的治疗原则出发,患者的选择和手术质控是整个治疗的关键,对于不同复发风险的患者需要采取不同的联合放疗的方案。

The technique of nipple-areola complex （NAC）-sparing mastectomy （NSM） facilitates the breast reconstruction due to preserving the skin and NAC of breast in the treatment of breast cancer. Key issues still remain controversial in NSM, in terms of the role of radiotherapy combined with NSM and sequence of radiotherapy and NSM, which arise from the consideration of the oncology safety. Some investigations addressed that post-NSM external beam irradiation and intra-operative radiotherapy （IORT） combined with NSM could reduce the local recurrence rate. Basedon the appropriate patient selection and good quality of surgery, radiotherapy would be applied in different strategies of combination with NSM according to the risk of loeal recurrence of the eaneer.