Nonoperative Management for Invasive Breast Cancer After Neoadjuvant Systemic Therapy: Conceptual Basis and Fundamental International Feasibility Clinical Trials
Nonoperative Management for Invasive Breast Cancer After Neoadjuvant Systemic Therapy: Conceptual Basis and Fundamental International Feasibility Clinical Trials
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DOI：
10.1245/s10434-017-5926-z
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发表时间：
2017-10-01
影响因子：
3.7
通讯作者：
Heil, Joerg
中科院分区：
文献类型：
--
作者：
Kuerer, Henry M.;Peeters, Marie-Jeanne T. F. D. Vrancken;Heil, Joerg
随着新辅助全身治疗（NST）和乳腺成像技术的进步，浸润性乳腺癌的非手术治疗的潜力已成为一个可行的选择时，利用细致的图像引导下经皮穿刺活检，以记录病理完全缓解。利用这种方法的可行性临床试验正在由来自世界各地的单一和多中心/合作小组的研究者团队进行。NST后单独进行成像在预测pCR方面缺乏足够的敏感性和特异性，因此不能用于临床选择省略手术的患者。根据最初报告的可行性研究，在NST后对残留病变（或如果发生完全放射学缓解，则在剩余金属夹周围）进行充分采样的成像似乎对于选择pCR患者以降低假阴性率至关重要，以确定范围为5 - 49%的未手术pCR。在这篇手稿中，描述了最近完成的、正在进行的和计划进行的临床可行性试验和一项新的手术省略试验。需要对通常用于接受标准乳腺癌手术的患者的所有诊断和治疗管理策略进行彻底的反思。一个路线图的基本问题和问题，将不得不解决的非手术乳腺癌管理领域的进展进行了详细描述。
With current advances in neoadjuvant systemic therapy (NST) and improved breast imaging, the potential of nonoperative therapy for invasive breast cancer has emerged as a viable option when utilizing meticulous image-guided percutaneous biopsy to document pathologic complete response. Feasibility clinical trials utilizing this approach are being performed by teams of investigators from single and multicenter/cooperative groups around the world. Imaging alone after NST lacks sufficient sensitivity and specificity in predicting pCR and therefore cannot be utilized for clinical selection of patients for omission of surgery. Imaging with adequate sampling after NST of the residual lesions (or around the remaining clip if a complete radiologic response occurs) appears to be essential in selecting patients with pCR to lower the false-negative rates based on initial reported feasibility studies to identify pCR without surgery that range from 5 to 49%. In this manuscript, recently completed, ongoing, and planned clinical feasibility trials and a new omission of surgery trial are described. Drastic rethinking of all diagnostic and therapeutic management strategies that are ordinarily utilized for patients who receive standard breast cancer surgery is required. A roadmap of essential questions and issues that will have to be resolved as the field of nonoperative breast cancer management advances is described in detail.