Multidisciplinary Locoregional Management of Breast Cancer
Ce dossier présente un ensemble d'articles concernant le traitement locorégional d'un cancer du sein
Locoregional therapy for breast cancer seeks to achieve several goals. First and foremost, it must provide long-term locoregional control, meaning survival without recurrence in the breast/chest wall or draining nodal basins. A large body of literature documents increasing success in achieving this goal, likely owing to improvements across the spectrum of breast cancer treatment, from screening to diagnosis, to surgical and radiation treatment, to systemic therapy.1 With long-term locoregional recurrence risk now well below 10% for the vast majority of patients with breast cancer, the focus of research initiatives has largely shifted toward morbidity mitigation and value innovation. For example, in the past 20 years, we have seen the introduction of sentinel lymph node biopsy in both the upfront and the neoadjuvant setting, with subsequent clinical trials providing data to support the omission of completion axillary dissection in nearly all node-negative patients and in an increasing proportion of node-positive patients.2-4 This practice trend has lowered the prevalence of lymphedema among breast cancer survivors and has thus led to substantial population-level improvements in quality of life. Other clear examples of optimizing locoregional therapy include solidification of breast-conserving therapy as the preferred local treatment strategy for most patients with early breast cancer,5 the establishment of more convenient hypofractionated whole-breast and partial-breast irradiation techniques,6,7 and improvements in oncoplastic breast surgery and postmastectomy breast reconstruction.
Journal of Clinical Oncology , commentaire en libre accès, 2019