乳腺癌新辅助治疗后局部区域处理降阶梯策略

The de-escalating strategy of local-regional management after neoadjuvant therapy in breast cancer

新辅助治疗(neoadjuvant therapy,NAT)在乳腺癌治疗中已得到广泛应用,随着对乳腺癌分子生物学研究的深入和NAT疗效的不断提高,临床实践中可依据NAT疗效与肿瘤负荷,优化患者NAT后局部区域处理策略,进行个体化、精准化治疗,为患者带来更大的生存获益及更高的生活质量。NAT后保乳手术关注的核心应该是残余肿瘤范围和疗效而非单纯的退缩模式。临床淋巴结阴性患者推荐NAT后行前哨淋巴结活检(sentinel lymph node biopsy,SLNB),临床N1期患者可通过NAT后SLNB降期保腋窝。我们可以充分利用全身治疗和放疗合理缩小手术范围并控制并发症,扩大疗效与生活质量的“净获益”。本文就乳腺癌NAT后局部区域处理降阶梯策略进行阐述。

Neoadjuvant therapy(NAT)has become an important part of breast cancer treatment,and the 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.The concern of breastconserving surgery after NAT should be the extent of residual tumor and efficacy rather than the simple shrinkage pattern.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.We can combine the benefits of systemic therapy and radiation therapy to narrow the scope of surgery and reduce complications,ultimately achieving a“net benefit”of breast cancer treatment.In this paper,we will discuss the de-escalating strategy of local-regional management after NAT in breast cancer.