Nodal Irradiation after Breast-Cancer Surgery in the Era of Effective Adjuvant Therapy  

Oleh:

Burstein, Harold J. ; Morrow, Monica

Jenis: Article from Journal - ilmiah internasional
Dalam koleksi: The New England Journal of Medicine (keterangan: ada di Proquest) vol. 373 no. 04 (Jul. 2015), page 379-381.

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Perpustakaan FK Nomor Panggil: N08.K Non-tandon: 1 (dapat dipinjam: 0) Tandon: tidak ada

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Isi artikel

Among women with breast cancer, rates of local recurrence in the ipsilateral breast, chest wall, or regional lymph nodes have decreased dramatically during the past 20 years.1 Contributing factors include standardized clinical approaches to breast imaging, surgery, pathological analysis, and radiotherapy, but a critical element has been the near universal application of adjuvant systemic therapy. Almost all patients with breast cancer now receive some form of adjuvant drug treatment. Systemic treatments have proved to be highly effective at reducing the risk of both distant relapse and local or regional recurrence, and stepwise innovations in systemic therapy have correspondingly further reduced the odds of breast-cancer recurrence at a distant or local–regional site.2 In addition, the tumor subtype is now recognized as a primary determinant of local recurrence,3 a fact that when paired with other prognostic factors (including age and nodal stage) has enabled better risk stratification and opened the door to tailoring local–regional management strategies. For most patients, the risks of local–regional recurrence after breast surgery are now extraordinarily low — often less than 5% during 10 years of follow-up. Recognition of the benefit of systemic therapy on local disease control has transformed breast surgery, reducing the need for axillary dissection among patients with node-positive breast cancers4 and avoiding breast reoperations aimed at achieving wider surgical margins.5

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