乳腺癌骨转移的综合治疗(附70例临床分析)

目的骨转移为乳腺癌的常见转移部位，其最大危害是骨痛，应采用一系列方法减轻骨痛，努力提高患者的生存质量。方法７０例乳腺癌骨转移患者采用化疗、放疗、内分泌、同位素和综合治疗，分单一方法治疗组和综合方法治疗组，观察治疗后疼痛缓解和功能障碍恢复情况，经ｔ检验得出结论。结果单一方法治疗中，内分泌和同位素治疗有效率高于单纯化疗和放疗；单一方法治疗有效率为５６．４％，综合治疗有效率为９０％，经统计学处理，Ｐ＜０．０１。结论单纯内分泌和同位素治疗优于单纯化疗和放疗，乳腺癌骨转移患者雌孕激素受体多为阳性，更适于内分泌治疗；综合治疗明显优于单一治疗，综合治疗中大剂量化疗加内分泌治疗效果最佳。     

乳腺癌骨转移和骨相关疾病临床诊疗专家共识(2008版)

乳腺癌骨转移在复发转移乳腺癌中的发生率为65%～75%.乳腺癌远处转移中,首发症状为骨转移者占27%～50%.骨痛、骨损伤、骨相关事件(skeletal related event,SRE)的发生及生活质量的降低是乳腺癌骨转移的常见并发症.SHE是指在临床试验中表明双膦酸盐类药物治疗失败的研究观察终点,一般定义为骨痛加剧或出现新的骨痛、病理性骨折、椎体压缩或变形、脊髓压迫、骨放疗、骨转移病灶进展及高钙血症等事件,是影响患者自主活动能力和生活质量的主要因素[1-3].     

81例乳腺癌首发骨转移的综合治疗分析

[目的]探讨乳腺癌首发骨转移的综合治疗及预后。[方法]81例乳腺癌首发骨转移患者,单一治疗方法为放疗、内照射、化疗;综合治疗方法有放疗加骨膦、放化疗加内分泌、内照射加放疗、化疗加骨膦。采用卡方检验及多因素回归分析骨转移有关因素、综合治疗及预后。[结果]全组患者疼痛Ⅰ级30例,Ⅱ级41例,Ⅲ级10例,治疗后CR28例（34.6%）,PR40例（49.3%）,NC13例（16.0%）,CR＋PR68例（83.9%）;单一治疗方法为放疗、内照射、化疗有效率为90%、75.1%和65%,组间比较疗效差异无显著性（P〉0.05）;放疗加骨膦、放化疗加内分泌、内照射加放疗、化疗加骨膦有效率分别是92.8%、88.6%、90.5%和80.1%,组间比较差异无统计学意义（P〉0.05）。单一方法总的有效率是74%,综合治疗总的有效率为88.6%;综合治疗总的疗效优于单一方法治疗（P〈0.05）。[结论]年轻的、非特殊型浸润性乳腺癌,肿块T2/T3,腋淋巴结转移≥4枚为首发骨转移的高危因素;综合治疗必须结合患者的实际情况,采用化疗、放疗、内分泌、同位素或骨溶解抑制剂在内的两种或两种以上方法的联合辅助治疗,预后相对较好。     

乳腺癌骨转移综合治疗的探讨（附48例临床报告）

在晚期乳腺癌中,骨转移是很常见的。由于70％以上的患者存在骨痛和功能障碍,影响患者的生存质量,癌症止痛及其姑息性治疗已成为WHO癌症控制规划的主要项目和UICC的重点课题之一[1]。我科从1989～1998年对48例乳腺癌骨转移的住院患者进行了包括放疗、化疗、同位素治疗和内分泌治疗在内的综合治疗,报告如下：     

^89Sr治疗乳腺癌多发性骨骼转移临床疗效评价

目的 评价89Sr治疗乳腺癌多发性骨骼转移的临床效果.方法 53例乳腺癌多发性骨转移患者,临床表现为不同程度骨痛,采用静脉注射89Sr治疗并进行疗效评价.结果 疼痛完全缓解21例,部分缓解24例,无缓解8例,总有效率为84.9%.未见明显骨髓抑制与肝肾脏功能损伤.结论 89Sr能快速、有效地缓解和治疗乳腺癌患者多发性骨转移引起的疼痛,是一种安全、有效的治疗方法.     

乳腺癌骨转移疼痛的综合治疗

目的　探讨缓解乳腺癌骨转移疼痛 ,恢复患者活动能力的方法。方法　 31例乳腺癌骨转移患者采用以CMFP或CAFP方案化疗为主 ,辅以放射性同位素或双磷酸盐类药物综合治疗 ,观察治疗后疼痛缓解、活动能力恢复及骨外转移灶的变化情况。结果　全组骨痛缓解率为 87.1 % (2 7/ 31 ) ,功能活动恢复 85 .7% (6/ 7) ,骨外转移灶的有效率为 67.9% (1 9/ 2 8)。结论　以化疗为主的综合治疗 ,不仅能较好地控制骨外转移灶的发展 ,而且能显著地缓解骨痛 ,恢复患者的活动能力     

乳腺癌骨转移综合治疗的初步探讨

乳腺癌骨转移随着乳腺癌发病的增加而增多 ,同时 ,由于各种治疗方法的进步 ,患者寿命的延长 ,使发生骨转移的机会也增多。骨转移疼痛的治疗对提高骨转移患者的生存质量有重要临床价值 [1]。我院 1996年 8月— 2 0 0 2年 8月采用局部放疗、化疗、内照射治疗、骨膦、内分泌及综合治疗治疗乳腺癌骨转移患者154例 ,现将结果报告如下。1　资料与方法1.1　一般资料　全组 154例均为女性 ,年龄 2 6岁～ 78岁 ,中位年龄 45岁。原发灶全部经病理证实。乳腺癌患者诊断骨转移前的治疗 :未治疗 2 2例 ,单纯手术 3 7例 ,手术 +放疗 +内分泌治疗 2 3例 ,手…     

乳腺癌骨转移过程中的分子机制

乳腺癌患者易发生骨转移。乳腺癌骨转移依赖多种细胞因子及蛋白的参与,是癌细胞与骨微环境相互作用的结果。骨转移患者常见骨痛、病理性骨折等骨相关事件(skeletal related event,SRE),严重影响患者生活质量及预后。了解乳腺癌骨转移的分子机制有助于对乳腺癌骨转移患者的诊断及治疗。作者就参与乳腺癌骨转移相关因子及分子机制进行了综述。     

帕米膦酸二钠(博宁)合并化疗治疗32例骨转移癌的近期疗效观察

骨转移癌常见于乳腺癌、前列腺癌、肺癌 ,其主要症状为难以控制的进行性骨痛。我科 1997年 2月～ 1998年 8月用帕米膦酸二钠 (博宁 )加化疗治疗骨转移癌 32例 ,以评价博宁在骨转移癌综合治疗中的作用。1　材料与方法1.1　一般资料本组患者 32例 ,男 7例 ,女 2 5例。年龄 31～71岁 ,平均年龄 56岁。均经病理和 (或 )细胞学确诊为恶性肿瘤 ,并经Ｘ线摄片、ＣＴ或ＥＣＴ检查证实骨广泛转移 ,临床症状均有骨痛 ,部分伴功能障碍。其中乳腺癌 12例 ,肺癌 9例 ,消化道癌 8例 ,鼻咽癌 2例 ,膀胱癌 1例 ,均为复治病例。按主诉疼痛分级法 (ｖｅｒｂａ1…     

乳腺癌骨转移的治疗现状与展望

目的:总结乳腺癌骨转移痛变治疗的新进展.方法:应用Medline及CNKI期刊全文数据库检索系统,以"乳腺癌、骨转移瘤和治疗"等为关键词,检索2004-2009年的相关文献,共检索到731条,纳入标准:1)骨转移瘤的特点和表现;2)骨转移肿瘤的核素治疗、放疗、手术治疗和化疗治疗;根据纳入标准,精选分析25篇文献.结果:乳腺癌患者病程中常见骨转移,治疗有双磷酸盐药物,化疗、放疗、放射性核素治疗和手术等,CT引导下的射频治疗是相对新的治疗方法,也有联合放疗和靶向药物治疗的实验研究在开展中.结论:针对乳腺癌骨转移瘤患者,长期、持续、有效的治疗方法是根据患者情况,选择性采用不同治疗措施的综合治疗.     

Clinical efficacy of bisphosphonate therapy for bone metastasis from breast cancer

Bisphosphonates inhibit osteoclastic bone resorption and are being used as treatment for bone metastases from breast cancer. Intravenous bisphosphonate therapy can significantly reduce skeletal related events (SREs) when administered concurrently with chemotherapy or endocrine therapy. In addition, intravenous bisphosphonate monotherapy is also able to alleviate cancer induced bone pain, and to improve bone metastases in some patients. Oral bisphosphonates are not routinely used for the treatment of bone metastases due to their low bioavailability. However, minodronate, a bisphosphonate 100-fold more potent than pamidronate, is now in phase II clinical studies in Japan, and may alter the role of oral bisphosphonates in the treatment of bone metastasis from breast cancer. The ASCO guidelines recommend that patients with osteolytic bone metastases be treated not with bisphosphonate monotherapy, but with concurrent bisphosphonate and systemic therapy. In addition, it is also recommended that current standards of care for cancer pain, analgesics and radiotherapy, should not be replaced with bisphosphonate therapy.     

Locally advanced breast cancer: The contribution of cytotoxic and endocrine treatment to radiotherapy: An EORTC breast cancer co-operative group trial (10792)

Patients with locally advanced carcinoma of the breast were randomized to receive either radiotherapy alone, radiotherapy + endocrine therapy, radiotherapy + chemotherapy or radiotherapy + endocrine therapy + chemotherapy. In 363 evaluable patients, time to first progression was delayed significantly by both endocrine treatment and chemotherapy, the greatest effect being achieved by the combination of endocrine treatment and chemotherapy. This effect was almost entirely due to a major effect of systemic treatment on time to loco-regional progression, for which the result is highly significant, rather than time to distant metastasis in which only a non-significant trend was observed. For survival, a trend was seen in favour of the combination of hormone treatment and chemotherapy, but this effect did not achieve statistical significance. This trial suggests that current endocrine and cytotoxic treatments are only of marginal value in improving the prognosis in locally advanced breast cancer.     

Current status of endocrine therapy for breast cancer

Endocrine therapy is usually indicated prior to chemotherapy as the first line therapy for metastatic breast cancer patients because of its milder toxicity. Patients who respond to a first-line endocrine therapy have a high chance of responding to a second-line endocrine therapy, and thus the responders to a first-line endocrine therapy would better be treated with second or third-line endocrine therapy. In the adjuvant setting, tamoxifen (antiestrogen) has been proven to improve the prognosis of both pre- and postmenopausal estrogen receptor positive breast cancer patients, and goserelin (LH-RH agonist) has been proven to improve prognosis in premenopausal women comparable to chemotherapy (CMF). Very recently, preliminary results have indicated that anastrozole (aromatase inhibitor) is superior to tamoxifen as adjuvant treatment for estrogen receptor positive postmenopausal breast cancer patients. In addition, the recent success of tamoxifen in a chemoprevention trial seems to have ushered in a new era wherein prevention of breast cancer is much more emphasized than treatment of established breast cancer.     

Phase 2 randomized trial of primary endocrine therapy versus chemotherapy in postmenopausal patients with estrogen receptor-positive breast cancer

BACKGROUND: Few studies have compared primary neoadjuvant endocrine therapy with neoadjuvant chemotherapy in breast cancer patients. The need for preoperative chemotherapy with doxorubicin or taxanes may be reduced in postmenopausal patients with estrogen receptor (ER)-positive and/or progesterone receptor (PgR)-positive tumors. This randomized, controlled, phase 2 study evaluated the efficacy of neoadjuvant chemotherapy compared with endocrine treatment with aromatase inhibitors in postmenopausal women with ER-positive and/or PgR-positive breast cancer. METHODS: Eligible patients were randomly assigned to receive neoadjuvant anastrozole 1 mg/day (n = 61) or exemestane 25 mg/day (n = 60) for 3 months or doxorubicin 60 mg/m(2) with paclitaxel 200 mg/m(2) (four 3-week cycles). Study end points included overall objective response determined by palpation, mammography, and ultrasound, and the number of patients who qualified for breast-conserving surgery and radiotherapy. RESULTS: Clinical objective response was 64% in the endocrine therapy and chemotherapy treatment groups. Median time to clinical response was 57 and 51 days with aromatase inhibitors and chemotherapy, respectively (P > .05). Rates of pathological complete response (3% vs 6%) and disease progression (9% vs 9%) did not differ significantly in the endocrine therapy or chemotherapy group, respectively (P > .05). Rates of breast-conserving surgery were slightly higher in the endocrine group (33% vs 24%; P = .058). The most frequent toxicities from chemotherapy were alopecia (79%), grade 3/4 neutropenia (33%), and grade 2 neuropathy (30%). Endocrine treatment was well tolerated. No deaths occurred during the preoperative treatment. CONCLUSIONS: Preoperative neoadjuvant endocrine therapy with aromatase inhibitors was well tolerated and resulted in rates similar to chemotherapy in overall objective response and breast-conserving surgery in postmenopausal women with ER-positive and/or PgR-positive tumors.     

Long-term results of breast-conserving treatment for early-stage breast cancer in Japanese women from multicenter investigation

BACKGROUND: Although many clinical data regarding breast-conserving treatment have already been reported from European and North American countries, few clinical data with long-term follow-up have been reported from Japan. METHOD: We collected information on therapeutic and possible or developed prognostic factors and follow-up data for Japanese women who had received breast-conserving treatment consisting of wide excision of the primary tumor, axillary dissection and radiotherapy for unilateral breast cancer considered suitable for breast-conserving treatment from 18 Japanese major breast cancer treating hospitals; 1561 patients were registered. RESULTS: The median follow-up period was 77 months. Five-year disease-free and overall survival rates were 89.4 and 95.9%, respectively. The 5-year local recurrence-free rate was 96.3%. The patients with histologically positive margins (P < 0.0001) or estrogen receptor negative tumor (P = 0.0340) or younger than 40 years old (P < 0.0001) developed statistically significantly more local recurrences. Adjuvant endocrine therapy was essential for the estrogen receptor positive patients to have a lower local recurrence rate. Endocrine therapy did not change the local recurrence rate among estrogen receptor negative patients at all. Multivariate analysis showed histological margin status and the combination of estrogen receptor status and endocrine therapy were independent prognostic factors for local recurrence. CONCLUSION: The 5-year local recurrence rate of Japanese breast cancer patients who were treated with breast-conserving treatment using radiotherapy was 3.7%. Independent prognostic factors for local recurrence were histological margin status and the combination of estrogen receptor status and adjuvant endocrine therapy.     

Targeting the PI3K/AKT/mTOR pathway in estrogen receptor-positive breast cancer

Approximately 70−75% of breast cancers express the estrogen receptor (ER), indicating a level of dependence on estrogen for growth. Endocrine therapy is an important class of target-directed therapy that blocks the growth-promoting effects of estrogen via ER. Although endocrine therapy continues to be the cornerstone of effective treatment of ER-positive (ER+) breast cancer, many patients with advanced ER+ breast cancer encounter de novo or acquired resistance and require more aggressive treatment such as chemotherapy. Novel approaches are needed to augment the benefit of existing endocrine therapies by prolonging time to disease progression, preventing or overcoming resistance, and delaying the use of chemotherapy.     

Successful endocrine chemotherapy in patients with multiple bone metastases of breast cancer--a case report]

A 54-year-old woman was admitted to our hospital with upper and lower back pain. She had previously developed multiple bone metastases of advanced breast cancer. Endocrine chemotherapy of tamoxifen citrate (TAM) 20 mg/day and carmofur (HCFU) 300 mg/day was started. Subsequently, medroxyprogesterone acetate (MPA) 600 mg/day and 5'-deoxy-5-fluorouridine (5'-DFUR) 600 mg/day were administered. In evaluating the treatment effect for symptomatic relief, partial response and performance status were judged to have improved from 4 to 2. At present, the patient is able to walk on her own to the hospital. She has lived 4 years with no newly developed lesions, and no adverse effects such as diarrhea or body weight gain have been observed. Substantial results can be achieved in patients with bone metastasis of breast cancer even with mild endocrine chemotherapy. A combination of radiotherapy, pain control, and orthopedic surgery suitable to each case is thought to be necessary.     

369例ER阳性乳腺癌辅助内分泌治疗的前瞻性临床研究

目的 评价ER阳性乳癌根治术后辅助内分泌治疗的效果。方法 ER阳性的根治性术后乳腺癌患者分为内分泌治疗及化疗两组,进行全身辅助治疗。内分泌治疗组194例,服用三苯氧胺（TAM）5年,其中绝经前患者均先切除双侧卵巢后再服用TAM。化疗组175例,主要采用CMFVP或CMF方案。结果 绝经后患者的内分泌治疗组和化疗组5年无病生存率分别为78．4％和45．4％（P＜0．01）,5年总生存率分别为83．3％和52．9％（P＜0．05）;绝经前患者的内分泌治疗组和化疗组5年无病生存率分别为72．8％和35．7％（P＜0．01）。5年总生存率分别为80．7％和60．0％（P＜0．05）。但是Ⅰ期患者及腋淋巴结转移≥8个的患者,两者疗效差异无显著性（P＞0．05）。结论 ER阳性乳腺癌术后辅助内分泌治疗效果优于或等于化疗。     

联合放化疗对乳腺癌患者心脏毒性的临床观察

 目的 观察联合放化疗与单一化疗对乳腺癌患者心肌的损伤。方法 接受含表柔比星化疗或联合放疗的术后乳腺癌患者共68例，对其治疗前后的心电图检查结果进行统计学分析。结果 表柔比星化疗配合放射治疗的乳腺癌患者的心脏毒性明显高于单一化疗组。放化疗组出现心电图异常的发生率为36.8 %（14例），单一化疗组出现心电图异常的发生率为10 %（3例），两组比较，差异有统计学意义（P＜0.05）。结论 联合放化疗增加乳腺癌患者的心脏毒性，建议乳腺癌患者在治疗期间定期复查心电图，尤其对年龄＞60岁和有高血压、心脏疾病病史的患者尤其重要。