乳腺癌个体化新辅助治疗

乳腺癌新辅助治疗是局部进展期乳腺癌的标准治疗方式。在早期乳腺癌中,大型临床试验显示新辅助治疗与辅助治疗具有相似的疗效,并能提高保乳手术的比例,使其在临床上被广泛接受,成为     

乳腺癌新辅助治疗几个热点问题

新辅助治疗可以为病人带来与辅助治疗相似的临床获益。新辅助治疗能够降低肿瘤负荷,从而使手术范围缩小,手术创伤减小。研究肿瘤对新辅助治疗的反应性可以获得重要的预后信息,更好地了解残余肿瘤的生物学行为。乳腺癌新辅助治疗方案的选择、新辅助治疗后手术及放疗的决策是临床医师应掌握和重视的问题。对乳腺癌病人实施规范化的新辅助治疗将有助于提高生存获益。     

乳腺癌的新辅助治疗

乳腺癌的新辅助治疗（neoadjuvant therapy,NAT）,最早开展的是新辅助化疗（neoadjuvant chemotherapy,NACT）,经过三十多年的研究,已经达成不少的共识,但还存在着广泛的争议。基本达成的共识有：NACT是局部晚期乳腺癌的标准治疗;NACT的疗效至少与辅助化疗相当;NACT可能增加保乳率;NACT后达到病理完全缓解（pathologieal complete remission,pCR）者有较高的生存率等等。主要的争议包括：乳腺癌NAT的定义和适应证;乳腺癌NACT能否提高生存率;     

乳腺癌新辅助治疗策略与手术时机

新辅助治疗(NAT)已成为乳腺癌治疗的重要组成部分,目前仍处于不断发展的阶段,应用日益广泛.在临床实践中应依据肿瘤生物学、疗效与肿瘤负荷,采用适应性研究设计,优化病人NAT策略,进行个体化、精准化治疗.NAT期间动态监测疗效,重视早期疗效评估和预测,推荐以疗效为导向制定后续治疗的决策.新辅助内分泌治疗逐渐受到关注.NA...     

新辅助治疗失败致乳腺癌不可切除2例报告

<正>大型III期临床研究及荟萃分析显示,合理应用新辅助治疗可以提高乳腺癌疗效,增加保留乳房的机会,也改变了乳腺癌首选手术治疗的单一传统治疗模式[1]。但是,新辅助治疗期间应及时评价疗效,以避免治疗无效病例丧失手术机会至关重要。本文报告笔者医院近期经治的2例新     

分子靶向药物在乳腺癌新辅助治疗中的应用

乳腺癌位居女性恶性肿瘤发病首位,近年来其罹患率逐年上升且渐呈年轻化趋势。虽然各种综合治疗手段已经提高了乳腺癌的疗效,但是有文献报道,超过20％的患者会出现复发转移以及对常规治疗耐药的现象。对此,人们一直致力于寻求新的治疗方法以改善乳腺癌的不良预后和转归。     

三阴性乳腺癌新辅助治疗现状

目的 三阴性乳腺癌高侵袭、高复发、高转移且预后差,对内分泌治疗、抗Her-2靶向治疗不敏感。本研究总结了近年来三阴性乳腺癌新辅助治疗进展。方法 应用PubMed、CNKI、万方等数据库,以“TNBC、新辅助治疗、病理完全缓解”等作为搜索关键词,检索近年的相关文献。结果 病理完全缓解被认为是新辅助治疗预后评判的重要标准之一。蒽环类联合紫杉类药物仍然是TNBC患者的首选新辅助化疗方案,铂类药物的应用使BRCA基因突变TNBC患者有了更优的新辅助化疗方案,但血液学、消化系统等相关不良反应不可忽视。免疫调定点抑制剂相关药物被证实在TNBC新辅助治疗上能提高pCR,改善长期生存预后,且因药物不良反应停药较铂类药物发生率更低。肿瘤微环境靶向药物、多聚ADP核糖聚合酶抑制剂、PI3K/AKT/mTOR通路抑制剂等相关药物在多药联合方面上的临床研究有积极治疗效果。结论 TNBC新辅助治疗中,化疗是基础,免疫治疗已有相关临床试验成果,肿瘤微环境靶向药物、多聚ADP核糖聚合酶抑制剂、PI3K/AKT/mTOR通路抑制剂具有很大研究前景。     

乳腺癌新辅助治疗前哨淋巴结处理原则

前哨淋巴结活检及新辅助治疗已成为乳腺癌综合治疗的重要措施,也是个体化治疗的重要体现.乳腺癌新辅助治疗具有较高的腋窝淋巴结控制率,如何在乳腺癌新辅助治疗病人中精准、高效实施前哨淋巴结活检引起越来越多的关注.新辅助治疗前后腋窝淋巴结状态的精准评估是实施前哨淋巴结活检的基础.对于新辅助治疗前腋窝淋巴结阴性的病人,推荐新辅助治...     

乳腺癌分子分型时代的新辅助治疗

在过去的20年中,随着对新辅助治疗模式认识的加深,其应用已不仅局限于局部晚期乳腺癌的降期治疗,而是作为认识肿瘤生物学行为、评估新兴治疗方案疗效的平台,广泛应用于早期乳腺癌的治疗。目前对于新辅助治疗的可选方案,在乳腺癌各版临床指南[1-2]中,均简述为:可参考乳腺癌的术后辅助治疗,进行术前全身系统治疗的方案选择。然而不同于术后辅助治疗,病人在接受新辅助治疗时,对于截然不同的肿瘤负荷,治疗的获益可能存     

芳香化酶抑制剂在乳腺癌新辅助治疗中的研究进展

近年来,新辅助内分泌治疗已成为乳腺癌的重要治疗手段,芳香化酶抑制剂为乳腺癌内分泌治疗的主要药物,目前共有3代产品,其作用机理已基本明了。现今,第1、2代芳香化酶抑制剂已逐渐被第3代产品所替代,本文重点对第3代芳香化酶抑制剂在乳腺癌术前治疗中的应用进行综述。     

Utility of neoadjuvant chemotherapy in the treatment of operable breast cancer

Neoadjuvant chemotherapy (NAC) is a legitimate alternative to first‐line surgical therapy for the treatment of breast cancer patients, as level one evidence shows the effect on overall survival is equivalent to that of adjuvant chemotherapy. In the treatment of women with operable breast cancer, NAC provides a number of potential advantages including: improving the chance of achieving breast‐conserving surgery, improving cosmesis after breast‐conserving surgery, downstaging the breast and axilla, allowing time to fully consider surgical options, time for genetic testing and facilitating breast reconstruction in otherwise high‐risk patients. However, in Australia, NAC is poorly utilized with less than 3% of women with operable breast cancer receiving NAC. This review discusses the potential harms and benefits of NAC, discusses areas of controversy in the use of NAC and describes how we have used NAC in our own practice. We conclude that if it is obviously necessary for the newly presenting breast cancer patient to have chemotherapy as part of the treatment, it is worth considering NAC. In many patients, the potential benefits of NAC outweigh the harms. However, maximizing these benefits is closely aligned with appropriate patient selection and timely multidisciplinary team communication.     

Sentinel lymph node mapping following neoadjuvant chemotherapy for breast cancer

The purpose of this study was to evaluate the feasibility of sentinel lymph node mapping in patients undergoing neoadjuvant chemotherapy for breast carcinoma prior to lumpectomy or mastectomy and sentinel lymph node mapping followed by complete axillary dissection. A retrospective analysis of 14 patients from February 1998 to July 2000 with stage I to stage IIIB breast cancer diagnosed by core biopsy underwent neoadjuvant chemotherapy (doxorubicin/cyclophosphamide) prior to definitive surgery, including lumpectomy or mastectomy and sentinel lymph node mapping, followed by full axillary dissection. Thirteen of 14 patients had successful sentinel lymph node identification (93%), and all 14 underwent full axillary dissection. An average of 2.2 sentinel nodes and a median of 16 axillary lymph nodes (including sentinel nodes) were found per patient. Of the 13 patients in whom a sentinel lymph node was identified, 10 were positive for metastases (77%). Only 4 of the 10 had further axillary metastases (40%). Three patients had negative sentinel lymph nodes shown by hematoxylin and eosin and cytokeratin stainings and had no axillary metastases (0% false negative). The single patient in whom a sentinel lymph node could not be identified had stage IIIA disease with extensive lymphatic tumor emboli. Sentinel lymph node mapping is feasible in neoadjuvant chemotherapy breast cancer patients and can spare a significant number of patients the morbidity of full axillary dissection. Further study to evaluate sentinel lymph node mapping in this patient population is warranted.     

乳腺癌诊治进展——多学科与个体化

乳腺癌诊治包括预防、筛检、早期诊断、局部与全身治疗等,均涉及多个科学领域。多学科诊治模式包括多学科门诊和多学科会议等,已为学术界广泛认可。循证医学以随机对照临床试验和荟萃分析为主要工具,在传统医学临床病理学指标的基础上,依据雌激素受体（ER）、孕激素受体（PR）、人表皮生长因子受体2（HER-2）等生物学指标将乳腺癌进一步分成不同类型的亚群。个体化策略是乳腺癌治疗所追求的目标,其任务是利用基因组学的方法找出与疾病预测和预后相关的临床生物学指标,提高疗效并且降低治疗的并发症发生率。     

Development of malignant breast microcalcifications after neoadjuvant chemotherapy in advanced breast cancer

The increased interest in the use of neoadjuvant chemotherapy for patients with locally advanced or large tumors at initial presentation necessitates the recognition of sequelae of this therapy. This article describes the interval appearance of malignant, linear-branching, microcalcifications during neoadjuvant chemotherapy for locally advanced breast cancer. Mammographically the malignant microcalcifications appeared only in the region of the breast where the primary tumor was found. Pathologically only a subpopulation of malignant cells responded to the chemotherapy, demonstrating viability of the majority of the tumor, with cell death only in the subpopulation. With the increased use of neoadjuvant chemotherapy, it is important to recognize previously undescribed mammographic findings secondary to this therapeutic approach.     

Diffusion-weighted imaging in evaluating the response to neoadjuvant breast cancer treatment

The aim of this study was to investigate the role of diffusion imaging in the evaluation of response to neoadjuvant breast cancer treatment by correlating apparent diffusion coefficient (ADC) value changes with pathological response. From June 2007 to June 2009, all consecutive patients with histopathologically confirmed breast cancer undergoing neoadjuvant chemotherapy were enrolled. All patients underwent magnetic resonance imaging (MRI) (including diffusion sequence) before and after neoadjuvant treatment. The ADC values obtained using two different methods of region of interest (ROI) placement before and after treatment were compared with MRI response (assessed using RECIST 1.1 criteria) and pathological response (assessed using Mandard's classification). Fifty-one women (mean age 48.41 years) were included in this study. Morphological MRI (RECIST classification) well evaluated the responder status after chemotherapy (TRG class; area-under-the-curve 0.865). Mean pretreatment ADC values obtained with the two different methods of ROI placement were 1.11 and 1.02 × 10(-3) mm(2) /seconds. Mean post-treatment ADC values were 1.40 and 1.35 × 10(-3) mm(2) /seconds, respectively. A significant inverse correlation between mean ADC increase and Mandard's classifications was observed for both the methods of ADC measurements. Diagnostic performance analysis revealed that the single ROI method has a superior diagnostic accuracy compared with the multiple ROIs method (accuracy: 82% versus 74%). The coupling of the diffusion imaging with the established morphological MRI provides superior evaluation of response to neoadjuvant chemotherapy treatment in breast cancer patients compared with morphological MRI alone. There is a potential in the future to optimize patient therapy on the basis of ADC value changes. Additional works are needed to determine whether these preliminary observed changes in tumor diffusion are a universal response to tumor cell death, and to more fully delineate the ability of ADC value changes in early recognizing responder from nonresponder patients.     

循环肿瘤细胞在乳腺癌新辅助化疗中的应用进展

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