Safety of Breast-Conserving Surgery in Breast Cancer and Risk of Overtreatment vs Undertreatment
Menée en Suède à partir de données 2008-2017 portant sur 48 986 patientes atteintes d'un cancer du sein traité par chirurgie (durée médiane de suivi : 6,3 ans), cette étude compare la survie globale après une chirurgie conservatrice du sein suivie d'une radiothérapie par rapport à une mastectomie suivie ou non d'une radiothérapie
The oncology community has advocated in favor of breast-conserving surgery (BCS) as an alternative to mastectomy in appropriately selected patients with breast cancer for several decades. This recommendation is supported by multiple prospective randomized clinical trials demonstrating overall survival equivalence for both operative approaches and is aligned with the paradigm shift in oncology to de-escalate all components of multidisciplinary care. Medical breast oncologists use less chemotherapy as a consequence of improved risk stratification by gene expression profiling and surgical breast oncology has also evolved. Today, the radical mastectomy is largely of historic significance; patients with early-stage breast cancer are routinely offered lumpectomy with sentinel node biopsy and radiation. Recent years have also witnessed efforts to de-escalate radiation therapy. The National Surgical Adjuvant Breast and Bowel Project B-06 trial established the landmark finding that several weeks of breast radiation after lumpectomy is necessary for local control but does not contribute to survival. However, since that time, efforts to minimize the cost, inconvenience, and cosmetic sequelae of radiation have resulted in widespread implementation of accelerated hypofractionated schedules, partial breast irradiation, and ongoing studies designed to identify lumpectomy patients that can omit radiation completely.
JAMA Surgery , éditorial, 2020