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乳腺癌保乳手术若干问题再讨论 总被引:3,自引:0,他引:3
申戈 《国外医学(肿瘤学分册)》2003,30(2):107-109
近年来乳腺癌的保乳手术得到认可,随访时间的延长越加证明其可行性,适应证不断扩大的的同时,手术前后的处理显得越来越重要。现综述近年来这方面最新进展。 相似文献
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乳腺癌术后辅助治疗最新指导原则 总被引:24,自引:0,他引:24
20 0 0年 1 1月 ,美国国家卫生研究院召开乳腺癌辅助治疗专题会议 ,参加会议的有来自全球各地的肿瘤内科学、放射肿瘤学、肿瘤外科学、病理学、卫生统计学和公共健康方面的专家。与会专家回顾讨论了 1 995年到 2 0 0 0年 ,公开发表的 2 2 30篇有关乳腺癌辅助治疗的文献 ,就乳腺癌辅助治疗原则达成一些共识 ,供医生和患者在决定治疗时参考。1 决定辅助治疗的预后指标决定乳腺癌术后辅助治疗的预后指标和预测指标可以分为 :( 1 )患者特征 ,如年龄、种族、社会经济因素 ;( 2 )疾病特征 ,如肿瘤大小和组织类型 ;( 3)生物学特征 ,如激素受体及癌… 相似文献
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近年来.乳腺癌的内分泌治疗受到了越来越广泛的重视.有关乳腺癌内分泌治疗的策略也正在发生着深刻变化。因此.正确把握乳腺癌的治疗策略,将有助于提高乳腺癌的内分泌治疗效果。 相似文献
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18年间乳腺癌治疗方法的演变 总被引:6,自引:1,他引:5
目的 :探讨手术、化疗和内分泌治疗方式的改变对乳腺癌预后的影响。方法 :1976~ 1993年住院的女性乳腺癌患者 2 311例 ,统计分析术式演变趋势和不同术式腋窝淋巴结清除的程度。以规范辅助化疗和内分泌治疗的1985年、1986年为界 ,分段比较各期患者所占比例及其 5年和 10年生存率。结果 :1984年以前根治术为乳腺癌治疗的主要术式 ,其后改良根治术成为主导术式。该 2种术式腋窝淋巴结平均清除数量相同。 1986年以后 、 期患者所占的比例均有显著提高 ,而 期、 期和总体患者的 5年生存率亦均有显著提高。 、 、 期和总体患者的 10年生存率均有提高趋势 ,但无统计学意义。结论 :改良根治术可以获得与根治术相同的腋窝淋巴结清除效果。规范应用全身性治疗措施是提高乳腺癌患者长期生存率的重要环节。 相似文献
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妊娠期乳腺癌的治疗进展和预后 总被引:1,自引:0,他引:1
随着妇女生育年龄向后推迟,妊娠期乳腺癌的发生率会增高。由于妊娠期妇女的解剖和生理性变化,使乳腺癌的诊断极具挑战性。一旦诊断明确,需要有多学科的治疗小组来参与完成治疗。病人及其家属可考虑是否终止妊娠。虽然中止妊娠可能不会影响乳腺癌的预后,但乳腺癌的各种治疗手段会对胎儿产生不良影响。改良根治术是主要的手术方式;妊娠中3个月和后3个月,可给予新辅助或辅助化疗。在整个妊娠期绝对禁止放疗;对于在妊娠后期确诊的病人,如果行保乳手术,术后放疗应推迟到分娩后进行。多数文献报道妊娠期乳腺癌病人与相同分期的非妊娠期病人的生存率无显著差别,但有的研究发现晚期妊娠期乳腺癌的病人预后要差。 相似文献
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《Expert review of anticancer therapy》2013,13(6):941-944
Breast cancer is the most common cancer in women and its incidence increases with age. Older women are not often offered optimal treatment compared with younger women for any particular stage. This is due to various reasons, including the lack of evidence for older women from well-conducted clinical trials. In this paper, the currently available evidences from clinical trials are reviewed and the various treatment options for older women with early breast cancer are discussed. 相似文献
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Syed BM Al-Khyatt W Johnston SJ Wong DW Winterbottom L Kennedy H Green AR Morgan DA Ellis IO Cheung KL 《British journal of cancer》2011,104(9):1393-1400
Introduction:
A Cochrane review of seven randomised trials (N=1571) comparing surgery and primary endocrine therapy (PET) (oestrogen receptor (ER) unselected) shows no difference in overall survival (OS). We report outcome of a large series with ER-positive (ER+) early invasive primary breast cancer.Methods:
Between 1973 and 2009, 1065 older (⩾70 years) women (median age 78 years (70–99)) had either surgery (N=449) or PET (N=616) as initial treatment.Results:
At 49-month median follow-up (longest 230 months), the 5-year breast cancer-specific survival (BCSS) and OS were 90 and 62%, respectively. Majority (74.2%) died from causes other than breast cancer. The rates (per annum) of local/regional recurrence (<1%) (following surgery), contralateral tumour (<1%) and metastases (<3%) were low. For patients on PET, 97.9% achieved clinical benefit (CB) at 6 months, with median time to progression of 49 months (longest 132 months) and significantly longer BCSS when compared with those who progressed (P<0.001). All patients with strongly ER+ (H-score >250) tumours achieved CB and had better BCSS (P<0.01). Patients with tumours having an H-score >250 were found to have equivalent BCSS regardless of treatment (surgery or PET; P=0.175), whereas for those with H-score ⩽250, surgery produced better outcome (P<0.001).Conclusion:
Older women with ER+ breast cancer appear to have excellent long-term outcome regardless of initial treatment. Majority also die from non-breast cancer causes. Although surgery remains the treatment of choice, patients with ER-rich (H-score >250) tumours tend to do equally well when treated by PET. This should be taken into account when therapies are considered. 相似文献13.
Rao VS Garimella V Hwang M Drew PJ 《International journal of cancer. Journal international du cancer》2007,120(6):1155-1160
Breast cancer is the most common malignancy in women with an age related increase in incidence ranging from 1 in 50 at age 50 to 1 in 10 at age 80. This is particularly significant in view of the changing demographics in the western population, characterised by an aging population and increased life expectancy. However in spite of favourable prognostic factors and less aggressive biological behaviour, elderly breast cancer patients receive less aggressive treatment when compared with their younger counterparts. Appropriate treatment should be offered depending on physiological reserve and comorbidities. Primary endocrine treatment has been shown to be associated with significant morbidity in terms of disease progression. Prompt surgery and adjuvant treatment can decrease relapse and improve survival. Radiation therapy is shown to decrease local relapse and chemotherapy may have a role in a select group of patients with adverse prognostic factors. With incidence of breast cancer bound to increase in the elderly population, it is essential to establish optimum therapy in this cohort of patients as studies reveal good outcome from standard treatment. 相似文献
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Mano M Fraser G McIlroy P Stirling L MacKay H Ritchie D Canney P 《Breast cancer research and treatment》2005,89(1):81-90
Elderly patients are more likely to present with locally advanced breast cancer than younger patients. Furthermore, due to the accelerated aging of the western population, the incidence of breast cancer in this population is expected to steadily rise in the coming decades. So far, no guidelines are available for the management of octogenarian patients presenting with inoperable disease, what frequently results in a dilemma for the treating physician. For the time being, these patients should be ideally treated within the context of a clinical trial. In all other cases, the treatment has to be individualised, frequently based on data extrapolated from different population of patients, or retrospective series. This article reviews the current evidence, options, and most promising approaches for these patients. 相似文献
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Kwast AB Liu L Roukema JA Voogd AC Jobsen JJ Coebergh JW Soerjomataram I Siesling S 《British journal of cancer》2012,107(3):549-555
Background:
This study examined the risk of third cancer of non-breast origin (TNBC) among women with bilateral breast cancer (BBC; either synchronous or metachronous), focussing on the relation with breast cancer treatment.Methods:
Risk was assessed, among 8752 Dutch women diagnosed with BBC between 1989 and 2008, using standardised incidence ratios (SIR) and Cox regression analyses to estimate the hazard ratio (HR) of TNBC for different treatment modalities.Results:
Significant increased SIRs were observed for all TNBCs combined, haematological malignancies, stomach, colorectal, non-melanoma skin, lung, head and neck, endometrial, and ovarian cancer. A 10-fold increased risk was found for ovarian cancer among women younger than 50 years (SIR=10.0, 95% confidence interval (CI)=5.3–17.4). Radiotherapy was associated with increased risks of all TNBCs combined (HR=1.3; 95%CI=1.1–1.6, respectively). Endocrine therapy was associated with increased risks of all TNBCs combined (HR=1.2; 95%CI=1.0–1.5), haematological malignancies (HR=2.0; 95%CI=1.1–3.9), and head and neck cancer (HR=3.3; 95%CI=1.1–10.4). After chemotherapy decreased risks were found for all TNBCs combined (HR=0.63; 95%CI=0.5–0.87).Conclusion:
Increased risk of TNBC could be influenced by genetic factors (ovarian cancer) or an effect of treatment (radiotherapy and endocrine therapy). More insight in the TNBC risk should further optimise and individualise treatment and surveillance protocols in (young) women with BBC. 相似文献16.
The aim of this study was to elicit the level of breast cancer awareness in older women. A cross-sectional study-specific questionnaire survey of 712 British women aged 67-73 years (response rate 83.8%), assessing knowledge of symptoms and risk and confidence to detect a change, was conducted. Over 85% of respondents were aware that a lump was a symptom of breast cancer but knowledge of non-lump symptoms was limited. Knowledge of risk was poor; 50% believed that the lifetime risk of developing breast cancer was less than 1 in 100 women and 75% were not aware that age is a risk factor. Thirty-one percent of women reported low levels of confidence to detect a breast change and 19% rarely or never checked their breasts. Those with fewer educational qualifications had poorer knowledge of symptoms, less awareness of lifetime and age-related risks, but were more likely to check their breasts than more highly educated women. This national survey demonstrates a significant lack of the prerequisite knowledge and confidence to detect a breast change. Raising breast cancer awareness and promoting early presentation among older women is important, as they are more at risk of breast cancer and more likely to delay seeking help with breast cancer symptoms than younger women. 相似文献
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G Mustacchi M E Cazzaniga P Pronzato A De Matteis F Di Costanzo I Floriani 《Annals of oncology》2007,18(6):991-996
BACKGROUND: The incidence of breast cancer increases with age, and the disease affects many older women; however, attitudes about prevention and treatment of breast cancer vary based on the patient's age. Older women have less access to clinical trials and fewer opportunities for treatment with innovative therapies. The National Oncological Research observatory on Adjuvant therapy in breast cancer (NORA) study was a cohort study designed to obtain information about adjuvant strategies for treatment of breast cancer after surgery, patterns of recurrence, and possible correlations between cancer-related events and biological factors. PATIENTS AND METHODS: This report describes patient characteristics, disease status, and local and systemic adjuvant treatments in a population of breast cancer patients aged >or=65 years. The NORA study consecutively enrolled >3500 patients from 2000 through 2002 at 77 Italian hospitals; of these, 1085 were aged >or=65 years. Data on patient characteristics, cancer presentation, and treatments were analyzed to identify possible relationships between these factors and age. RESULTS: The findings indicate that age is significantly related to later diagnosis and different patterns of treatment. Choice of adjuvant systemic treatment was primarily related to hormone receptor status and tumor stage but was strongly influenced by the patient's age; there was a proportional relationship between endocrine treatment and increasing age. Cyclophosphamide, methotrexate, and 5-fluorouracil as well as anthracyclines were widely used, but the use of taxanes was limited to a very small percentage of patients. CONCLUSIONS: The findings of the NORA study may help to change attitudes that currently exclude a significant proportion of breast cancer patients from secondary prevention policies, more active treatment strategies, and clinical research trials based on age. 相似文献