Reimagining Deintensification for Low-Risk Breast Cancer.

IF 4.7 3区 医学 Q1 ONCOLOGY
Chirag Shah, Megan Kruse, Zahraa Al-Hilli
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Abstract

As outcomes for low-risk breast cancer continue to improve, research and clinical paradigms are increasingly focused on appropriate deintensification with the goal of improving the therapeutic ratio of breast cancer treatment. These deintensification approaches span across disciplines including breast surgery, radiation therapy, and systemic therapy. With regard to breast surgery, studies have continued to push deintensification when it comes to surgical margins with breast conservation, reducing re-excision rates, whereas deintensification of axillary surgery has reduced the rates of axillary lymph node dissection and increasingly the need for any axillary surgery, including sentinel lymph node biopsy for low-risk patients. With regard to radiation therapy, studies have allowed for a drastic reduction in treatment duration, whereas approaches that reduce the target of treatment have led to a change from from treatment daily for 5-7 weeks to many low-risk patients completing treatment in just five treatments. With regard to systemic therapy, use of genomic assays and tumor biology has led to reduced utilization of cytotoxic chemotherapy, with studies also allowing for dose reduction of endocrine therapy for patients with ductal carcinoma in situ. Moving forward, greater focus should be placed on interdisciplinary deintensification approaches such as the consideration of radiation therapy alone as compared with endocrine therapy alone for low-risk breast cancers.

重新认识低风险乳腺癌的去强化治疗。
随着低危乳腺癌治疗效果的不断改善,研究和临床范例越来越关注适当的减敏治疗,以提高乳腺癌治疗的治疗率。这些减敏方法涉及多个学科,包括乳腺外科、放射治疗和全身治疗。在乳腺手术方面,研究继续推动在保留乳房的手术切缘方面去强化,以降低再次切除率,而腋窝手术的去强化则降低了腋窝淋巴结清扫率,并越来越多地减少了对任何腋窝手术的需求,包括对低风险患者进行前哨淋巴结活检。在放射治疗方面,研究结果表明,治疗时间可以大大缩短,而减少治疗目标的方法已经从每天治疗 5-7 周转变为许多低风险患者只需 5 次治疗即可完成治疗。在全身治疗方面,基因组检测和肿瘤生物学的应用减少了细胞毒性化疗的使用,研究还允许减少导管原位癌患者的内分泌治疗剂量。展望未来,应更加重视跨学科的减毒方法,如考虑对低风险乳腺癌患者进行单纯放疗与单纯内分泌治疗的比较。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
6.40
自引率
7.50%
发文量
518
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