乳腺癌患者术后长期内分泌治疗的不良反应及治疗策略

内分泌治疗是乳腺癌患者术后治疗的重要手段,目前临床应用的主要药物有选择性雌激素受体调节剂他莫昔芬和芳香化酶抑制剂阿那曲唑、来曲唑及依西美坦。乳腺癌术后辅助内分泌治疗通常需要5年,部分患者可长达10年。他莫昔芬治疗引起的不良反应主要包括妇科和心血管系统不良反应。处理措施为定期检测子宫内膜及血压、血脂等指标,对症处理。芳香化酶抑制剂治疗引起的不良反应主要包括：（1）骨不良反应。处理措施为根据情况予以维生素D和钙剂治疗,必要时给予双膦酸盐类药物。（2）关节肌肉症状。病情较轻者可补充维生素D和钙剂,并进行适当体育锻炼;疼痛明显者可服用非甾体类抗炎药,也可以考虑停药3-4周。（3）心血管系统不良反应。处理措施为对症处理。

Long-term endocrine therapy-related adverse drug reactions in patients after breast cancer surgery and treatment strategies

Endocrine therapy is an important treatment method for patients after breast cancer surgery. At the present,selective estrogen receptor modulator（ such as tamoxifen）and aromatase inhibitors （ such as anastrozole,letrozole,and exemestane）are main treatment drugs for patients after breast cancer surgery. The patients receiving adjuvant endocrine therapy need usually about 5 years and some patients need 10 years. The adverse reactions induced by tamoxifen were symptoms related to gynecology and cardiovascular system. The treatment measures include regular detection of the patients＆#39; endometrium, pressure,and blood lipid,etc. and symptomatic treatments. The adverse reactions induced by aromatase inhibitors are as follows.（1）Adverse reactions related to bone. The treatment measures are supplement of vitamin D and calcium,and bisphosphonates maybe given. （ 2 ）Joint and muscle symptoms. The patients with mild symptoms are given vitamin D,calcium,and appropriate physical exercise. The patients in marked symptoms are given non steroidal anti-inflammatory drugs or the treatment drugs are stopped for 3-4 weeks. （3）Adverse reactions in cardiovascular system. The patients are given symptomatic treatments.