乳腺癌化疗文件材料教学稿件.pptVIP

乳腺癌化疗 安徽医科大学第一附属医院肿瘤内科 陈振东 systemic therapies, based on tumor histology clinical and pathologic characteristics axillary node status hormone receptor content level of HER2/ expression metastatic disease Comorbidity age menopausal status. Patient preference Ⅰ,ⅡA,ⅡB期:治疗 保乳与根治效果相同(1级) 腋淋巴结阴性,HER2/neu阳性,蒽环类抗生素为主方案化疗(2B级) HER2/neu假阳性需要重视 IHC或FISH检测 HER2/neu优劣尚不清楚，倾向于后者优于前者 化疗完成后放疗。放疗可以和CMF同时，但放疗期间不用MTX，或至多不超过2 个疗程(影响保乳的美容效果) 肿瘤较大的ⅡA,ⅡB及T3N1M0：术前化疗 确诊要用粗针穿剌活检，可以在瘤床预置钉以便日后手术 目标在于保留乳房 对于 Ⅱ期乳腺癌, 尚无证据表明术前化疗比术后化疗有生存优势 化疗一般为四个周期 如果多周期术前化疗无效，应立即手术 肿瘤较大的ⅡA,ⅡB及T3N1M0：术前内分泌治疗 demonstrate that the use of either anastrozole or letrozole alone provide superior rates of breast conserving surgery and usually objective response. adjuvant endocrine therapy in postmenopausal women with early breast cancer aromatase inhibitors either as initial adjuvant therapy, sequentially following 2-3 years of tamoxifen, or as extended therapy following 4.5 - 6 years of tamoxifen. aromatase inhibitors are not active in the treatment of women with functioning ovaries. adjuvant endocrine therapy The Arimidex, Tamoxifen, Alone or in Combination Trial (ATAC Trial) demonstrates that anastrozole is superior to tamoxifen or the combination of tamoxifen and anastrozole in the adjuvant endocrine therapy of postmenopausal women with hormone receptor-positive breast cancer. 预后不良因素 脉管浸润 高的核分级 高的组织学分级 HER2过表达 激素受体阴性 预后较好因素 管状腺癌 粘液癌 髓样癌（高的核分级，伴有淋巴细胞浸润，肿瘤边界膨胀性生长）现在认为易于转移，且不同病理医生间诊断意见常不能统一，故应该与其他浸润性导管导管癌同等看待 women over age 70 should be individualized, consideration of comorbid conditions. Inoperable locally advanced breast cancer clinical stage IIIA except for T3N1M0 clinical stage IIIB clinical stage IIIC Inoperable locally advanced breast cancer: 评估 骨扫描(2B) 胸腹部CT／B超/MRI (2B) 肿瘤标记物以及对无症状病人进行常规骨扫描，对生存或减缓疾病复发无帮助 Inoperable locally advanced breast cancer the initial use of anthracycline-based preoperative chemotherapy is standard therapy. Local therapy after preoperative therapy usually consis