课件：乳腺癌的保乳手术20090627.ppt

90%的专家支持SLNB作为除T4d期外，临床腋淋巴结阴性浸润性乳腺癌患者的标准治疗。当存在前哨淋巴结微转移或孤立肿瘤细胞时，69%的专家不同意对所有患者避免行腋清扫术，但对于有选择的患者，92%的专家认为可以避免腋清扫术。 放疗是乳腺癌局部和区域治疗的重要措施，也是保留乳房治疗的重要组成部分。近年来对保乳手术后全乳照射的必要性提出了质疑，其依据是在单独应用保乳手术而不加放射治疗的患者中发生的同侧肿瘤复发主要集中在原手术切口附近。因此提出了部分乳腺照射的设想，所采用的技术包括间质放疗、适形超分割放疗及术中放疗，他们的共同目的就是为了缩短放疗时间和减轻放疗对正常组织的损伤。 与综合治疗的时间配合：切缘阴性患者辅助化疗完成后2-4周内开始术后放疗，含蒽环类和紫杉类的化疗方案不建议与放疗同期使用。没有辅助化疗指征的患者在术后8周以内开始放疗。 放疗使同侧乳腺复发下降 Slide 16: Milan III - Local Failure Then we went on, tried to identify if radiotherapy was needed or was perhaps, too, could be avoided anyway, and so we compared a typical breast conservative surgery plus radiotherapy with the same operation without radiotherapy, and again, an increase, a considerable increase in number of local recurrences, and this again in a certain way expected. And of course, now we know that we don~ want recurrence, we have to give radiotherapy after breast conservative surgery. 米兰－III局部复发 然后，我们继续探讨是否放疗是必须的或也许可以避免的。所以我们把保乳手术加放疗和不加放疗进行对比。同样可以发现，不加放疗组的局部复发增加，同样也是意料之中的。我们不想看到复发，所以我们应当在保乳手术后进行放疗。 Vaida医师说，许多被诊断为早期乳腺癌的病人不愿意接受肿瘤局部切除术的原因是，她们不能在术后接受长达6周的每日放疗，因此，只选择乳房全切术。 部分乳腺照射（partial breast irradiation,PBI） 是指在原发肿瘤大小和部位的基础上、以银夹标记范围或术腔显示范围向外扩相应的边界作为靶区的乳腺癌保乳术后照射技术。目前所有实现 PBI的技术都是通过加速照射的方式实现的，因此也称其为加速部分乳腺照射（APBI）The Advantages of HDR Brachytherapy:Overall treatment time is 1 week versus 6 to 7 weeks for external beam radiation therapy. Conserve your breast and yield excellent cosmetic results. Breast brachytherapy delivers a precisely targeted dose to the tissues most at risk for recurrence, increasing the likelihood of tumor control. Reduces radiation dose to the lungs and opposite breast. Avoids potential long term side effects by reducing radiation doses to healthy tissue. Breast brachytherapy causes no delays in other treatments such as chemotherapy. Placement of the applicator (Tube and Button or Mammosite balloon) is simple and safe. Treatment is given on an outpatient basis, so no hospital stay is required. 组织间插植PBI Interstitial brachytherapy间质短距离放