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Breast J:广泛肿瘤成型术---需要乳房切除患者的保乳新方法

2015-02-19 candy译 MedSci原创

Extreme oncoplasty是一种乳腺癌保乳手术,使用oncoplastic技术,针对被大多数医生建议需要切除乳房的患者。这些患者通常具有大于等于5cm的多发性病灶或多中心癌肿。很多已经确定有淋巴结转移。大多数乳癌患者需要放射治疗,甚至是乳房全切术。66例多灶性,多中心,或原发晚期肿瘤的病例作为本次研究的对象,其癌肿超过50mm(极端病例)。所有患者均接受了切除和oncoplastic重建

Extreme oncoplasty是一种乳腺癌保乳手术,使用oncoplastic技术,针对被大多数医生建议需要切除乳房的患者。这些患者通常具有大于等于5cm的多发性病灶或多中心癌肿。很多已经确定有淋巴结转移。大多数乳癌患者需要放射治疗,甚至是乳房全切术。66例多灶性,多中心,或原发晚期肿瘤的病例作为本次研究的对象,其癌肿超过50mm(极端病例)。所有患者均接受了切除和oncoplastic重建术和为了对称立刻施行对侧手术,使用一个标准或明智的分割模式。所有为了促进瘤床的全乳放疗患者都接受了postexcisional标准。这些极端案例与345例肿瘤超过50mm或稍小的单发或多发性肿瘤的连续病例(标准病例)进行对比。所有将保乳作为次要选择的极端病例均被建议施以乳房全切术。诊断评估包括数字钼靶、B超、MRI和PET-CT(若有侵入)。标准的病例做得非常出色:在245例病例中肿瘤无墨水(即乳癌肿块切缘阴性)达到了96%。肿块中等大小为21mm(平均有23mm),而切缘大于等于1mm可以达到88.6%。17例标准病例(6.9%)为了达到更大的边缘而经历再切除,只有1个病例(0.4%)被转为施以乳房全切术。通过24个月的追踪,有3例(1.2%)发生了原位复发。对于极端病例,在接受标准局部病灶切除术后,与被发布的确切边缘比例比较,无墨肿瘤达到83.3%。肿块中等大小为62mm(平均66mm)。切缘大于等于1mm能够达到54.5%。6例(9.1%)极端病例为了达到更大的边缘经历了再切除,有4例(6.1%)被转为施以乳房全切术。通过24个月的追踪后,1例(1.5%)发生了原位复发。


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Extreme oncoplasty是一种有前景的全新的概念。在挑选出的大于5cm多病灶或多中心的癌肿例,Extreme oncoplasty可成功地保乳。它可能对以化疗作为辅助疗法的原位癌晚期病人同样有效。从生命质量的观点出发,这是一个比乳房全切术、重建和放射联合治疗更佳的选择。长期统计的复发率与生存率显示这个方法是有效的。根据历史数据,预期原位癌的复发将会稍微更高,但是对生存率几乎无影响。

文章来源:Silverstein, M. J., et al. (2015). "Extreme oncoplasty: breast conservation for patients who need mastectomy." Breast J 21(1): 52-59.

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  2. [GetPortalCommentsPageByObjectIdResponse(id=1903080, encodeId=29d319030807c, content=<a href='/topic/show?id=e1b0583884b' target=_blank style='color:#2F92EE;'>#新方法#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=63, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=58388, encryptionId=e1b0583884b, topicName=新方法)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=c22f171, createdName=kord1982, createdTime=Fri May 01 22:50:00 CST 2015, time=2015-05-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=23693, encodeId=9a322369314, content=很不错学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=174, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=/v1.0.0/img/user_icon.png, createdBy=ac181616815, createdName=ljjj1053, createdTime=Sat May 16 19:29:00 CST 2015, time=2015-05-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1710784, encodeId=9a5b1e107843c, content=<a href='/topic/show?id=9a1c289680' target=_blank style='color:#2F92EE;'>#AST#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=115, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=2896, encryptionId=9a1c289680, topicName=AST)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=8b9831894722, createdName=ms24272190615788285182, createdTime=Thu Jul 02 12:50:00 CST 2015, time=2015-07-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=16710, encodeId=081a16e10e8, content=不错的文章,学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=185, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=f2fb1607679, createdName=orthoW, createdTime=Sun Feb 22 09:24:00 CST 2015, time=2015-02-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1351064, encodeId=4c111351064ec, content=<a href='/topic/show?id=12e43e1263' target=_blank style='color:#2F92EE;'>#Breast#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=97, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=3712, encryptionId=12e43e1263, topicName=Breast)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4c37265, createdName=zhaojie88, createdTime=Sat Feb 21 02:50:00 CST 2015, time=2015-02-21, status=1, ipAttribution=)]
    2015-05-16 ljjj1053

    很不错学习了

    0

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  4. [GetPortalCommentsPageByObjectIdResponse(id=1903080, encodeId=29d319030807c, content=<a href='/topic/show?id=e1b0583884b' target=_blank style='color:#2F92EE;'>#新方法#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=63, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=58388, encryptionId=e1b0583884b, topicName=新方法)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=c22f171, createdName=kord1982, createdTime=Fri May 01 22:50:00 CST 2015, time=2015-05-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=23693, encodeId=9a322369314, content=很不错学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=174, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=/v1.0.0/img/user_icon.png, createdBy=ac181616815, createdName=ljjj1053, createdTime=Sat May 16 19:29:00 CST 2015, time=2015-05-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1710784, encodeId=9a5b1e107843c, content=<a href='/topic/show?id=9a1c289680' target=_blank style='color:#2F92EE;'>#AST#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=115, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=2896, encryptionId=9a1c289680, topicName=AST)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=8b9831894722, createdName=ms24272190615788285182, createdTime=Thu Jul 02 12:50:00 CST 2015, time=2015-07-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=16710, encodeId=081a16e10e8, content=不错的文章,学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=185, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=f2fb1607679, createdName=orthoW, createdTime=Sun Feb 22 09:24:00 CST 2015, time=2015-02-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1351064, encodeId=4c111351064ec, content=<a href='/topic/show?id=12e43e1263' target=_blank style='color:#2F92EE;'>#Breast#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=97, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=3712, encryptionId=12e43e1263, topicName=Breast)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4c37265, createdName=zhaojie88, createdTime=Sat Feb 21 02:50:00 CST 2015, time=2015-02-21, status=1, ipAttribution=)]
    2015-02-22 orthoW

    不错的文章,学习了

    0

  5. [GetPortalCommentsPageByObjectIdResponse(id=1903080, encodeId=29d319030807c, content=<a href='/topic/show?id=e1b0583884b' target=_blank style='color:#2F92EE;'>#新方法#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=63, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=58388, encryptionId=e1b0583884b, topicName=新方法)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=c22f171, createdName=kord1982, createdTime=Fri May 01 22:50:00 CST 2015, time=2015-05-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=23693, encodeId=9a322369314, content=很不错学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=174, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=/v1.0.0/img/user_icon.png, createdBy=ac181616815, createdName=ljjj1053, createdTime=Sat May 16 19:29:00 CST 2015, time=2015-05-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1710784, encodeId=9a5b1e107843c, content=<a href='/topic/show?id=9a1c289680' target=_blank style='color:#2F92EE;'>#AST#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=115, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=2896, encryptionId=9a1c289680, topicName=AST)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=8b9831894722, createdName=ms24272190615788285182, createdTime=Thu Jul 02 12:50:00 CST 2015, time=2015-07-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=16710, encodeId=081a16e10e8, content=不错的文章,学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=185, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=f2fb1607679, createdName=orthoW, createdTime=Sun Feb 22 09:24:00 CST 2015, time=2015-02-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1351064, encodeId=4c111351064ec, content=<a href='/topic/show?id=12e43e1263' target=_blank style='color:#2F92EE;'>#Breast#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=97, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=3712, encryptionId=12e43e1263, topicName=Breast)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4c37265, createdName=zhaojie88, createdTime=Sat Feb 21 02:50:00 CST 2015, time=2015-02-21, status=1, ipAttribution=)]
    2015-02-21 zhaojie88

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