乳腺癌的药物治疗进展

目的 探讨乳腺癌化疗,内分泌治疗,化疗与内分泌治疗联合应用以及晚期乳腺癌全身治疗的最新进展。方法 复习近近的文献并对其进行综述。结果 临床上新 不断开发明显提高乳腺癌治疗的总有效率。化疗与内分泌治疗联合应用的治疗效果则根据病人的受体状况,月经状态以及腋淋巴结受累情况而有明显差异。结论 乳腺癌药物治疗应根据病人年龄、病理分期、月经状态、受体状况等个体比特征选择不同的治疗方案。     

乳腺癌的药物治疗进展

乳腺癌是一个全身性疾病。随着对乳腺癌生物学特性的更深入认识，导致了乳腺癌的治疗模式发生了明显的改变。近10年来，Ⅰ、Ⅱ期乳腺癌外科治疗的手术范围在缩小。国外有价值的前瞻性随机临床试验对保留乳房与根治性乳房切除手术的临床疗效进行了比较，其结果都一致认为两组的生存差异无统计学意义。同时，多种抗癌新药的问世，新辅助化疗或早期化疗能缩小原发灶，增加保乳机会，并减少或杀灭亚临床转移。与此对应的是，全身性药物治疗的作用日益突出，化疗、内分泌治疗和基因治疗等已成为当前确有成效的全身治疗方法。     

乳腺癌正规治疗后对侧乳腺癌发生的危险因素分析

目的 探讨女性初发乳腺癌治疗后再发对侧乳腺癌(contralateral breast cancer, CBC)的危险因素.方法 回顾性分析我院1997年1月至2002年12月期间收治的340例女性初发乳腺癌患者的临床资料,包括患者的年龄、病理结果、手术方式、化疗、放疗、激素治疗具体方案和执行情况等.采用Kaplan-Meier法评估CBC的发生率,Cox部分相关回归评估CBC的相关危险因素.结果 14例诊断为CBC,总发病率为4.1%.10年CBC发生率(2.7%)高于5年CBC发生率(1.4%),随着随访时间的延长发生率逐年升高.单因素分析提示,患者年龄≤45岁、乳腺癌家族史、病理学分型为髓样癌及未采取内分泌治疗为5年和10年CBC发生的危险因素(P＜0.05),而化疗和放疗与否为CBC发生的非危险相关因素(P＞0.05).多因素分析表明,其中年龄≤45岁及乳腺内放疗为5年和10年CBC发生的独立危险因素(P＜0.05).结论 对于≤45岁、髓样癌、有乳腺癌家族史的初发乳腺癌患者应警惕CBC的发生; 初发乳腺癌患者应采取内分泌治疗,避免乳腺内放疗以降低CBC的发生率.     

乳腺癌内分泌治疗的再认识

乳腺癌是一种激素依赖性的全身性疾病,其治疗手段有手术、放疗、化疗和内分泌治疗,其中内分泌治疗以其独特的作用和有效性受到了越来越多的关注。人们已注意到与细胞毒性化疗相比,内分泌治疗有以下特点:①疗效反应可通过测定肿瘤细胞内的雌激素受体(ER)和(或)孕激素受体(PR)水平而预测;②急性毒性和长期毒性低,病人的生活质量较高;③显效时间缓慢,通常需治疗2至8周起效,一旦出现缓解,则缓解期可持续1年以上;④一种内分泌疗法有效者,对其他各种内分泌疗法有效的可能性很大。乳腺癌内分泌疗法的临床应用改变了一些传统的治疗观念。乳腺癌内…     

放疗在乳腺癌治疗中的作用

近20年来,随着放射治疗技术的发展,放疗在乳腺癌治疗中的作用和地位也随之发生较大的变革.这种变革突出地表现在以下三个方面:一是放疗作为根治性治疗手段与保留乳房手术相结合,获得与根治性手术相同的治疗效果;二是放疗作为术后辅助性治疗手段,使腋淋巴结阳性及高危复发病人的局部控制率及生存率提高;三是放疗已成为晚期乳腺癌姑息治疗的主要手段,特别是对于某些有症状的转移病灶,放疗是首选的治疗方法.     

乳腺癌辅助内分泌治疗

内分泌治疗适用于激素敏感性肿瘤。70％乳腺癌细胞膜表面有雌激素或者孕激素受体表达，为激素敏感性肿瘤。     

乳腺癌内分泌治疗共识与争议

正临床上大约有60%~75%的乳腺癌患者激素受体(hormone receptor,HR)阳性,对于这些患者,辅助性内分泌治疗可以显著降低疾病复发率,从而提高患者的总生存率~([1])。我们根据已有的临床实践证据,对以下几个问题进行综述:HR阳性患者如何接受优化的内分泌治疗,不同患者是否有最优的药物选择和时长,在接受内分泌治疗的过程中出现耐药后该如何调整药     

乳腺癌患者综合治疗后肺部早期放射性反应

作者总结了经过手术、放疗和化疗等综合治疗的６２例乳腺癌病例。化疗用ＣＭＦ或ＣＡＭＦ方案。肺部早期放射性反应的发生率为１１．３％（７例），而且早期肺放射性反应发生率均发生于含阿霉素的ＣＡＭＦ化疗方案病例中，说明阿霉素与放射治疗合并使用会增加早期肺放射性反应的发生率。因此，综合治疗中，为了既得到好的治疗效果又减少肺部早期放射性反应的发生，对于用阿霉素化疗的病例，我们应该适当控制总照射剂量，精确设计放射野。     

年龄小于35岁的年轻乳腺癌患者个体化治疗的思考

虽然年轻人的乳腺癌发病率较低,但是因为年轻患者涉及很多复杂议题值得特别关注。对于“年轻”的界定还存在争论,目前有不少研究证实,年龄〈35岁是乳腺癌独立的预后因素,因此,我们将年轻乳腺癌患者定义为年龄〈35岁的患者。年轻乳腺癌患者比较特殊,有其独特的生理和病理特点,其综合治疗在治疗疾病的同时,还会对年轻患者的生理健康和心理健康产生影响,因此,现重点阐述年轻乳腺癌患者的特点以及应该给予特别关注的一些议题。     

Mammography of Breast Cancer in Women Under 30

Abstract: The purpose of this study was to assess the efficacy of mammography of breast cancer in women less than 30 years old. A retrospective record review revealed 47 breast cancers in 45 women age 29 and younger who had preoperative mammography. Patients ranged in age from 22 to 29 years (mean = 27 years). All presented with clinically evident disease. Mammography revealed focal abnormality in 26 (55.3%) of 47 cases. Specific positive mammographic findings (n = 22) included uncalcified mass in ten (45.5%), calcification without mass in nine (40.9%), mass and calcifications in two (9.1%), and skin ulceration in one. Mammographic parenchymal density ( n = 21) was P2 in 9 (42.9%) and DY in 12 (57.1%). The mean time interval from symptom onset to biopsy was 4.5 months, but was shorter if the mammogram was positive. High parenchymal density contributes to the diminished sensitivity of mammography in women under age 30. A positive mammogram may hasten the diagnosis of carcinoma in a young woman with palpable malignant breast disease.     

Milestones in Breast Cancer Treatment

Modern treatment started in the 1880s with Halsted's mastectomy. The next milestone—a century later—was breast‐conserving surgery, with equivalent survival but better esthetic outcomes than mastectomy. Sentinel node biopsy, introduced in the 1990s, was a milestone that permitted avoidance of axillary dissection if the sentinel node was disease‐free. Chemotherapy was established for early breast cancer in the 1980s and its efficacy continues to improve; however side effects remain a concern, particularly since chemotherapy does not benefit most patients. External whole breast irradiation was introduced with conservative surgery, as it reduces recurrences. By the 2000s, 3‐week regimens had been shown equivalent to standard 6‐week regimens—easing pressure on patients and radiation centers. Intraoperative partial breast irradiation is potentially more beneficial as it permits complete local treatment in a single session; however, trials show that patients must be very carefully selected. From the 1990s irradiation technology was combined with imaging and computer technologies to produce equipment that directs radiation to more precisely defined target volumes, allowing increased dose to the target and markedly reduced dose to nearby tissues. Irradiation systems are evolving rapidly but are being implemented without data on long‐term morbidity or efficacy, while costs rise steeply. The first targeted treatment was tamoxifen, a selective estrogen receptor inhibitor. Since its widespread use starting in the 1980s, tamoxifen has saved the lives or prolonged the survival of millions with estrogen‐positive disease; it is cheap and has limited (but not negligible) side effects. The same cannot be said of newer targeted treatments like trastuzumab and pertuzumab, which, although effective against human epidermal growth factor receptor 2‐positive cancer, come with important side effects and huge costs. Breast cancer mortality is declining in rich countries, but treatments have become more demanding and more expensive, so the outlook for the increasing numbers of women worldwide who develop the disease is uncertain.