组成为保乳手术和随后放射治疗的保乳治疗（BCT）对于早期乳腺癌妇女来说是一个与乳房切除术同等的选择。尽管自多年以来国际指南已经常规推荐新辅助系统治疗（NAST）后进行BCT，但全球BCT的比率差异很大，其潜力仍未充分利用。虽然在西方国家，BCT的比率在过去几十年里已经增加到目前约为70％，但在其他国家，BCT的比率却只有10％左右。在本综述中，我们将评估NAST后乳房保留的潜力未被充分利用，确定原因，并讨论可能的解决方案。我们发现，导致NAST后BCT未被充分利用的原因包括患者、医生和社区对于肿瘤学结果的不确定性，正确定位肿瘤、多中心和多灶肿瘤的管理、边缘评估、社会经济因素在患者和国家层面上的差异以及影响患者和医生共同决策过程的心理偏见。缓解NAST后BCT未被充分利用的可能解决方案包括跨学科团队，优化治疗咨询和共同决策，以及针对性的财务支持以缓解不平等现象。版权所有©2023 Elsevier Ltd.发布。

Breast conserving therapy (BCT), consisting of breast conserving surgery and subsequent radiotherapy, is an equivalent option to mastectomy for women with early breast cancer. Although BCT after neoadjuvant systemic treatment (NAST) has been routinely recommend by international guidelines since many years, the rate of BCT worldwide varies largely and its potential is still underused. While the rate of BCT in western countries has increased over the past decades to currently about 70%, the rate of BCT is as low as 10% in other countries. In this review, we will evaluate the underused potential of breast conservation after NAST, identify causes, and discuss possible solutions. We identified clinical and non-clinical causes for the underuse of BCT after NAST including uncertainties within the community regarding oncologic outcomes, the correct tumor localization after NAST, the management of multifocal and multicentric tumors, margin assessment, disparities of socio-economic aspects on a patient and national level, and psychological biases affecting the shared decision-making process between patients and clinicians. Possible solutions to mitigate the underuse of BCT after NAST include interdisciplinary teams that keep the whole patient pathway in mind, optimized treatment counseling and shared decision-making, and targeted financial support to alleviate disparities.Copyright © 2023. Published by Elsevier Ltd.