Management of Local Disease Only

只有局部病变的处理

Patients with local recurrence only are divided into 3 groups: those who had been treated initially by mastectomy alone, those who had been treated initially by mastectomy plus radiation therapy, and those who had received breast-conserving therapy.山东省肿瘤防治研究院肿瘤内科张品良

只有局部复发的患者被分为3组：最初单纯乳腺切除术者、已经接受过乳腺切除加放射治疗者和已经接受过保乳治疗的患者。

In one retrospective study of local recurrence patterns in women with breast cancer who had undergone mastectomy and adjuvant chemotherapy without radiation therapy, the most common sites of local recurrence were at the chest wall and the supraclavicular lymph nodes.

在一项回顾性研究中分析了经历乳房切除术和化疗未进行放射治疗的乳腺癌女性局部复发模式，局部复发最常见的部位是在胸壁及锁骨上淋巴结。

The recommendations for treatment of the population of patients experiencing a local recurrence only are supported by analyses of a combined database of patients from the EORTC 10801 and Danish Breast Cancer Cooperative Group 82TM trials.

在只有局部复发的患者群中的治疗建议被EORTC 10801和丹麦乳腺癌协作组82TM试验合并数据库分析支持。

The analyses compared breast-conserving therapy with mastectomy in patients with stage I and stage II disease.

分析比较了保乳治疗的Ⅰ期和Ⅱ期乳腺癌患者。

The 133 (approximately 8%) patients experiencing a local recurrence as an initial event were approximately equally divided between those who had undergone mastectomy and those who had received breast-conserving therapy as initial treatment for breast cancer.

133例（约8%）患者出现了局部复发，作为一个初始事件，在接受乳腺切除术和保乳治疗作为乳腺癌初始治疗的患者之间大致相等。

Of those in the former group, 51 (76%) were able to undergo radiation therapy with or without surgery as treatment for local disease recurrence.

在前一组中，51例（76%）患者接受放射治疗加或不加局部复发病变的手术治疗。

No difference in survival emerged between patients receiving treatment after initial treatment with mastectomy or breast-conserving therapy; approximately 50% of both groups were alive at 10-year follow-up.

在最初接受乳腺切除术或者保乳治疗的患者中生存没有出现差异；在10年随访时两组大约都有50%的患者生存。

According to the NCCN Panel, mastectomy-treated patients should undergo surgical resection of the local recurrence (if it can be accomplished without heroic surgery) and involved-field radiation therapy to the chest wall and supraclavicular area (if the chest wall was not previously treated or if additional radiation therapy may be safely administered).

根据NCCN小组，乳房切除术治疗的患者局部复发应进行手术切除（如果不需要创伤性大手术即可完成）和胸壁及锁骨上区累及野放射治疗（如果胸壁以前没有治疗或额外放射治疗可以安全地实施）。

The use of surgical resection in this setting implies the use of limited excision of disease with the goal of obtaining clear margins of resection.

在这种情况下使用手术切除意味着用有限的疾病切除获得明确的切缘目的。

Unresectable chest wall recurrent disease should be treated with radiation therapy if no prior radiation has been given.

不可切除的胸壁复发疾病如果既往未曾给予放射应该放射治疗。

Women with a local recurrence of disease after initial breast-conserving therapy should undergo a total mastectomy and axillary staging if a level I/II axillary dissection was not previously performed.

在最初保乳治疗后疾病局部复发的女性，如果以前没有进行I/II级腋窝淋巴结清扫术应进行全乳房切除术和腋窝分期。

Limited data suggest that a repeat SLN biopsy following local recurrence of disease may be successfully performed in 80% of women who have previously undergone breast-conserving therapy and sentinel node biopsy.

有限的数据表明，在疾病局部复发后重做SLN活检可以在既往接受保乳手术和前哨淋巴结活检的女性中80%成功实施。

The consensus of the panel is that the preferred surgical approach for most women with a local recurrence following breast-conserving therapy and sentinel node biopsy is mastectomy and a level I/II axillary dissection, although sentinel node biopsy in lieu of a level I/II axillary dissection can be considered if prior axillary staging was done by sentinel node biopsy only.

专家小组的共识是，对于大多数保乳治疗和前哨淋巴结活检术后局部复发的乳腺癌女性首选乳房切除术和Ⅰ/Ⅱ级腋窝淋巴结清扫术，然而如果既往腋窝分期只是前哨淋巴结活检，则前哨淋巴结活检可以考虑代替Ⅰ/Ⅱ级腋窝淋巴结清扫术。

The results of the CALOR trial found that after complete resection in patients with isolated locoregional recurrence, adjuvant chemotherapy improves both DFS and OS.

该试验的结果发现，孤立的局部复发患者完全切除术后辅助化疗DFS和OS两者均改善。

After median follow-up of 4.9 years, the overall DFS was 69% in the chemotherapy group versus 57% in the group that did not receive chemotherapy (HR = 0.59, P = .046).

经过4.9年的随访，总的DFS在化疗组为69%而未接受化疗组为57%（HR = 0.59，P = .046）。

Five- year OS in all patients in the study was also significantly improved with chemotherapy (88% vs. 76%, P = .024).

在所有研究的患者中5年OS化疗组也有显著改善（88%对76%，P= .024）。

The benefit of adjuvant chemotherapy was mostly seen in women with ER-negative disease.

在雌激素受体阴性的女性中，辅助化疗的获益最多见。

Among women with ER-negative disease, 5-year DFS was 67% versus 35% (HR = 0.32, 95% CI = 0.14-0.73) and in those ER-positive disease, the 5-year DFS was 70% versus 69% (HR = 0.94, 95% CI 430 0.47-1.89).

ER阴性疾病的妇女中，5年无病生存率为67%和35%（HR = 0.32，95% CI =0.14-0.73）而在ER阳性患者中，5年无病生存率为70%和69%（HR = 0.94，95% CI 0.47-1.89）。

According to the NCCN Panel, after local treatment, women with local recurrences only should be considered for limited duration systemic chemotherapy or endocrine therapy similar to that outlined in the adjuvant chemotherapy section.

按照NCCN小组的意见，在局部治疗后仅仅局部复发的女性应考虑与辅助化疗部分描述相似的有限期限的全身化疗或内分泌治疗。

The panel emphasized the importance of individualizing treatment strategies in patients with a recurrence of disease limited to a local site.

该小组强调在疾病局限于局部复发的患者中个体化治疗策略的重要性。