乳腺癌新辅助治疗策略与手术时机

The strategy and surgery timing of neoadjuvant therapy in breast cancer

新辅助治疗(NAT)已成为乳腺癌治疗的重要组成部分,目前仍处于不断发展的阶段,应用日益广泛。在临床实践中应依据肿瘤生物学、疗效与肿瘤负荷,采用适应性研究设计,优化病人NAT策略,进行个体化、精准化治疗。NAT期间动态监测疗效,重视早期疗效评估和预测,推荐以疗效为导向制定后续治疗的决策。新辅助内分泌治疗逐渐受到关注。NAT有效的病人手术应于NAT结束后的21 d内完成,对于NAT无效病人鼓励其在NAT平台上积极寻找有效的无交叉耐药方案。临床淋巴结阴性病人推荐NAT后行前哨淋巴结活检(SLNB),临床淋巴结分期cN1病人可通过NAT后SLNB降期避免腋窝淋巴结清扫。

Neoadjuvant therapy(NAT)has become an important part of breast cancer treatment,which is still in a stage of continuous development,and its application is increasingly widespread.In clinical practice,we should adopt adaptive research design according to tumor biology,effect and tumor burden.At the same time,it is important to optimize the strategy of NAT and carry out precise treatment.During NAT,the effect should be dynamically monitored,and early evaluation and prediction of effect are important.There is growing interest in the use of neoadjuvant endocrine therapy in treatment of hormone receptor positive primary tumors.It is recommended that time interval between completion of NAT and breast surgery would less than 21 days.Ineffective patients are encouraged to actively seek effective non-crossresistance solutions on the NAT platform.Patients with clinical nodal negative are recommended to undergo sentinel lymph node biopsy after NAT,and patients with clinical nodal staging cN1 could receive axillary downstaging surgery after NAT.