术前系统治疗指南.pptVIP

NCCN Guidelines Version 3.2014 Preoperative Systemic Therapy Guideline of breast-conserving therapy Absolute: Radiation therapy during pregnancy（注：邻近分娩时，可先期手术，将放射治疗延迟至分娩以后时才考虑保乳 ） Diffuse suspicious or malignant-appearing microcalcifications（弥漫可疑/癌性微钙化灶） Widespread disease that cannot be incorporated by local excision through a single incision that achieves negative margins with a satisfactory cosmetic result（注：多灶、多中心为禁忌） Positive pathologic margin Contraindications for breast-conserving therapy requiring radiation therapy include: Relative: Prior radiation therapy to the chest wall or breast Active connective tissue disease involving the skin (especially scleroderma and lupus （注：因不能耐受放疗，可能导致严重的纤维化和软组织或骨的坏死) Tumors 5 cm (category 2B) Focally positive margin（注：显微镜下不伴有广泛导管内癌成分的局灶性阳性切缘可选择性保乳，更高剂量的瘤床推照） Women with a known or suspected genetic predisposition to breast cancer: 1）May have an increased risk of ipsilateral breast recurrence（患侧复发） or contralateral（对侧） breast cancer with breast-conserving therapy 2）Prophylactic bilateral mastectomy for risk reduction may be considered（预防性双乳切除）. Contraindications for breast-conserving therapy requiring radiation therapy include: Stage IIA T2, N0, M0 Stage IIB T2, N1, M0；T3, N0, M0 Stage lllA T3, N1, M0 Fulfills criteria for breast-conserving surgery except for tumor size CLINICAL STAGE History and physical exam CBC, platelets Liver function tests and alkaline phosphatase Bilateral mammogram（双乳X线）; Ultrasound Pathology review Tumor ER/PR status and HER2 status Genetic counseling if patient is high risk for hereditary(遗传) breast cancer Breast MRI (optional), with special consideration for mammographically occult（钼靶隐匿） tumors Fertility counseling if premenopausal（绝经前） Consider systemic staging (particularly if signs and symptoms are present): Chest diagnostic CT Abdominal（腹） ± pelvic（盆） diagnostic CT or MRI Bone scan or sodium fluoride（氟化钠：主评骨） PET/CT (category 2B) FDG PET/CT (optional, category 2B) WORKUP Desires breast p