乳腺癌治療的新研究

When breast cancer has spread to a patient's lymph system, surgeons traditionally have operated to remove a large number of underarm lymph nodes, to eliminate any trace of the cancer. The procedure is effective, but it can cause permanent complications. Now, a new study shows there is no advantage to taking out so many lymph nodes, and the finding could mean major changes in breast cancer surgery.

當乳癌細胞擴散到淋巴腺時，傳統的治療方法是，切除病人腋下下大部分淋巴結，以消滅所有癌細胞。這種手術固然有效果，但是也可能會引起永久性的併發症。現在，一項新的研究顯示，切除這麼多的淋巴結沒有好處。這個發現可能爲乳癌外科手術帶來重大改變。

When breast cancer spreads to nearby lymph nodes, doctors have two choices: they can remove the main tumor and the one or two lymph nodes closest to it. This is called sentinal node biopsy. Or, they can go with a more aggressive approach and take out a large number of lymph nodes.

當乳癌細胞擴散到附近的淋巴結時，醫生有兩個選擇：他們可以切除腫瘤和最靠近腫瘤的一、兩個淋巴結。這種手術叫做“前哨淋巴結活檢”。另一個選擇是更爲激進的方法，就是連同大部分淋巴結一起切除的根治性手術。

The more aggressive approach can wipe out the cancer, but complications often include shoulder pain or permanent and painful swelling of the arm.

根治性手術可以清除所有的癌細胞，但是通常會有併發症，包括肩痛以及手臂長期腫痛。

Dr. Armando Giuliano at the John Wayne Cancer Institute in the western state of California wanted to see if the cancer could be eliminated with less aggressive surgery. "Removing fewer lymph nodes results in less pain, less morbidity,” he said. “It's an outpatient procedure."

加州的約翰韋恩癌症研究所醫生阿爾曼多·吉烏利亞諾想知道，能不能用比較緩和的方式清除癌細胞。他說：“切除較少的淋巴結能使痛苦少些，併發症少些，而且這種手術在門診就可以做。”

The more radical surgery requires a one- or two-day stay in a hospital, and results in greater post-operative pain.

接受根治性手術的病人需要住院一天至兩天，手術疼痛比較嚴重。

So Bobbie Saunders was relieved when her doctor offered to perform the less radical procedure when she was diagnosed with breast cancer eight years ago. "I had already experienced a lot of people that had been through the radical, so I was really excited that I was offered this," she stated.

因此，8年前，當醫生告訴乳癌患者博比·桑德斯，準備爲她做比較簡單的手術時，她如釋重負。桑德斯說：“我接觸過很多接受根治性手術的病人。所以當我知道我要做的是這種緩和手術時，我很高興。”

Dr. Giuliano and researchers at several top cancer centers in the U.S. studied nearly 900 patients whose breast cancer had spread to just one or two lymph nodes. Half had the more radical procedure while the others had the simpler surgery. Both groups had radiation treatments and chemotherapy.

吉烏利亞諾醫生和美國一些頂尖癌症中心的研究人員研究了近900名癌細胞擴散到一個至兩個淋巴結的病患。其中有半數接受根治性手術，另一半接受比較簡單的手術。兩組病人都做了放療和化療。

"The five-year survival [rate] was about 92 percent, regardless of which operation [they had]. And wonderfully, women who had the sentinal node biopsy alone did just as well as the women who had the more radical operation," Dr. Giuliano explains.

吉烏利亞諾說：“不論病人做的是哪種手術，存活率都是大約百分之92。令人欣慰的是，接受前哨淋巴結活檢和接受根治性手術的婦女治療的效果相同。”

Researchers say combining chemotherapy and radiation with the simpler surgery accounts for the high success rate of the less radical procedure.

研究人員說，較簡單的手術與化療和放療配合，是這種手術高成功率的原因。

Some experts say the study is likely to change the way surgeons treat early-stage breast cancers that have spread to the lymph nodes. But other cancer specialists -- and their patients -- say they want more proof before changing the standard practice. The study was published in the Journal of the American Medical Association.

有專家說，這項研究結果可能會改變對早期乳癌擴散至淋巴結的手術治療方式。但是也有癌症專家和他們的病人表示，在改變治療方式之前，他們希望看到更多的證據。