Oncology Frontier: Is there any difference in the reconstruction time for in situ carcinomas versus locally advanced breast cancer?

　　《肿瘤瞭望》：对于原位癌及局部晚期乳腺癌而言，乳房再造时机是否有所不同？

　　Dr. Clough: That is a very good question. In situ carcinomas are when you do a mastectomy， you never do a post mastectomy radiotherapy. In situ carcinomas are perfect candidates for immediate reconstruction. These patients are offered systemic immediate reconstruction. Locally advanced breast cancer gets into a multidisciplinary treatment starting with chemotherapy and the only patients who get mastectomy at the end of chemo are the patients who did not respond to chemo， so these are probably the worst cases for immediate reconstruction.

　　Clough教授：这是个非常好的问题。对原位乳腺癌患者而言，在进行乳房切除术后绝对不需要放疗，因此可进行系统的即刻乳房再造。对局部晚期乳腺癌患者而言，进行多学科综合治疗时应首先化疗，化疗结束后对化疗无反应的患者可进行乳房切除术，故可能不太适合行即刻乳房再造。

　　Oncology Frontier: Going back to that thought about the multidiscipline approach， can you speak more specifically to the surgeons role in that group?

　　《肿瘤瞭望》：就多学科协作而言，能否请您更专业地评价一下外科医生在多学科团队中的作用？

　　Dr. Clough: Well， if a patient is into a multidisciplinary team， this means that her tumor is not an in situ carcinoma because sometimes she might get chemo， so we are dealing with invasive breast cancer. The surgeon has to see the patient up front before chemo， because the decision upon the final surgery will be made on the difference between the tumor before any treatment， and the tumor at the end of chemo. The surgeon has to see the patient initially together with the medical oncologist and see the patient again at the end of the chemo in order to make the proper decision of the best operation.

　　Clough教授：患者接受多学科团队诊疗就意味着其乳腺癌并非原位癌，而是浸润性乳腺癌，故有时可能需要化疗。鉴于最终手术决策主要需要根据尚未接受任何治疗前与化疗后肿瘤的差异决定，故外科医生需要在患者化疗前就见到患者。也就是说，外科医生需要在一开始就需共同与医学肿瘤学家对患者诊疗，并在化疗结束后再次见患者以确定其最佳手术方案。