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Breast Cancer |
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Treatment |
治療 | |
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Hormone therapy includes tamoxifen and aromatase inhibitors. Tamoxifen competitively binds estrogen receptors. Aromatase inhibitors (anastrozole, exemestane, letrozole) block peripheral production of estrogen in postmenopausal women. Benefit of hormone therapy is greatest when tumors have estrogen and progesterone receptors, nearly as good when they have only estrogen receptors, minimal when they have only progesterone receptors, and absent when they have neither receptor. In patients with ER+ tumors, particularly low-risk tumors, hormone therapy may be used instead of chemotherapy. Aromatase inhibitors have recently been proven more effective than tamoxifen and are becoming the preferred treatment for early-stage breast cancer in receptor-positive postmenopausal patients. Adjuvant tamoxifen for 5 yr reduces annual odds of death by about 25% in premenopausal and postmenopausal women regardless of axillary lymph node involvement; treatment for 2 yr is not as effective, but treatment for > 5 yr has no advantage and may increase the likelihood that any recurrent cancer is tamoxifen-resistant. Letrozole may be used for postmenopausal women who have completed 5 yr of daily tamoxifen. |
激素治療包括三苯氧胺和芳香酶抑制劑。三苯氧胺與雌激素受體結(jié)合力。芳香酶抑制劑（阿那曲唑、依西美坦、來曲唑)阻斷絕經(jīng)后婦女周圍雌激素的產(chǎn)生。當腫瘤含有雌激素和黃體激素受體時，激素治療的益處最大，腫瘤只含有雌激素受體時療效也差不多，只含黃體激素時療效最差，兩種受體都不存在時就沒有療效。ER＋腫瘤病人，特別是低危險腫瘤病人，激素治療可用于替代化療。最近證明，芳香酶抑制劑比三苯氧胺更有效，它已成為受體陽性絕經(jīng)后婦女早期乳腺癌治療的首選藥物。輔助性三苯氧胺治療5年可使絕經(jīng)前和絕經(jīng)后婦女死亡率減少25%左右，不管有無淋巴結(jié)受累。治療2年的效果就沒這么好，但治療> 5年則無益，且會增加復發(fā)癌對三苯氧胺產(chǎn)生抗藥性的可能。來曲唑可用于連續(xù)5年、每天服用三苯氧胺的絕經(jīng)后婦女。 | |
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Tamoxifen can induce or exacerbate menopausal symptoms but reduces incidence of contralateral breast cancer and lowers serum cholesterol. Tamoxifen improves bone density in postmenopausal women, and there is some evidence of fracture reduction. Tamoxifen may reduce cardiovascular mortality risk. However, it significantly increases risk of developing endometrial cancer; reported incidence is 1% in postmenopausal women after 5 yr of use. Thus, if such women have spotting or bleeding, they must be evaluated for endometrial cancer. Nonetheless, the improved survival for women with breast cancer far outweighs increased risk of death due to endometrial cancer. Unlike tamoxifen, aromatase inhibitors do not cause menopausal symptoms, but they may increase risk of osteoporosis. |
三苯氧胺會誘發(fā)或加重絕經(jīng)期癥狀，但可減少對側(cè)乳腺癌的發(fā)生率，降低血清膽固醇。三苯氧胺改善絕經(jīng)后婦女的骨密度，并可減少骨折的發(fā)生。三苯氧胺可以減少心血管病死亡危險，但也會大幅增加子宮內(nèi)膜癌的危險。根據(jù)報道，絕經(jīng)期婦女服用5年后的發(fā)病率為1%。因此，一旦這些婦女出現(xiàn)斑點或出血，就必須作子宮內(nèi)膜癌危險檢查。然而，與內(nèi)膜癌死亡危險增加相比，乳腺癌婦女處長壽命的好處更大。與三苯氧胺不同的是，芳香抑制劑不會引起絕經(jīng)期癥狀，但可增加骨質(zhì)疏松癥危險。 | |
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Metastatic disease: Any indication of metastases should prompt immediate evaluation. Treatment of metastases increases median survival by only 3 to 6 mo, although relatively toxic therapies (eg, chemotherapy) may palliate symptoms and improve quality of life; the decision to undergo treatment is highly personal.醫(yī)學 全在.線提供www.med126.com |
轉(zhuǎn)移性疾�。喝魏无D(zhuǎn)移癥狀都應(yīng)立即進行評估。轉(zhuǎn)移治療可使平均生存期增加3－6個月，盡管一些相對毒性的療法（如化療)也可以減輕癥狀改善生活質(zhì)量。是否進行這種治療完全取決于個人。醫(yī).學.全.在.線.網(wǎng).站.提供 | |
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Choice of therapy depends on the hormone-receptor status of the tumor, length of the disease-free interval (from diagnosis to manifestation of metastases), number of metastatic sites and organs affected, and patient's menopausal status. Most patients with symptomatic metastatic disease are treated with systemic hormone therapy or chemotherapy. Radiation therapy alone may be used to treat isolated, symptomatic bone lesions or local skin recurrences not amenable to surgical resection. Radiation therapy is the most effective treatment for brain metastases, occasionally achieving long-term control. Patients with multiple metastatic sites outside the CNS should initially be given systemic therapy. There is no proof that treatment of asymptomatic metastases substantially increases survival, and it may reduce quality of life. |
選擇何種療法取決于腫瘤的激素受體狀況、無病間隔期（從診斷到轉(zhuǎn)移出現(xiàn))長短、轉(zhuǎn)移部位及器官的數(shù)量和病人的絕經(jīng)期狀況。大多數(shù)有全身轉(zhuǎn)移性疾病的病人用全身性激素治療或化療。對單個、有癥狀骨損或經(jīng)不起外科手術(shù)的局部皮膚復發(fā)單獨放療即可。放射治療對腦轉(zhuǎn)移最有效，有時可獲得長期控制效果。中樞神經(jīng)系統(tǒng)以外有多處轉(zhuǎn)移的病人開始時應(yīng)作全身治療。沒有證據(jù)表明無癥狀轉(zhuǎn)移疾病治療能實質(zhì)性增加生存期，它可能會降低生活質(zhì)量。 | |
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Hormone therapy is preferred over chemotherapy for patients with ER+ tumors, a disease-free interval of > 2 yr, or disease that is not life threatening. Tamoxifen is often used first in premenopausal women. Ovarian ablation by surgery, radiation therapy, or use of a luteinizing-releasing hormone agonist (eg, buserelin, goserelin, leuprolide) is a reasonable alternative. Some experts combine ovarian ablation with tamoxifen therapy. If the cancer initially responds to hormone therapy but progresses months or years later, additional forms of hormone therapy may be used sequentially until no further response is seen. Aromatase inhibitors are being increasingly used as primary hormone therapy in postmenopausal women. |
對ER＋腫瘤病人，無病間隔期＞2年或疾病不威脅病人生命的，可采用激素治療而非化療。絕經(jīng)前婦女常先用三苯氧胺，也可考慮采用卵巢手術(shù)切除、放療、或使用黃體生成素釋放激素促效劑（如布舍瑞林、戈舍瑞林、醋酸亮丙瑞林)等療法。一些專家將卵巢切除與三苯氨胺治療相結(jié)合。如果癌癥開始時激素治療有效，幾個月或幾年后疾病繼續(xù)發(fā)展的，就應(yīng)采用別的激素治療，直到不再看到進一步的反應(yīng)。芳香酶抑制劑正越來越多地用于絕經(jīng)后婦女的一線激素治療。 | |
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The most effective cytotoxic drugs for treatment of metastatic breast cancer are capecitabine, doxorubicin, gemcitabine, the taxanes paclitaxel and docetaxel, and vinorelbine. Response rate to a combination of drugs is higher than that to a single drug, but survival is not improved and toxicity is increased. Thus, some oncologists use single drugs sequentially. |
治療轉(zhuǎn)移性乳腺癌的最有效細胞毒類藥有卡培他濱、阿霉素、二氟脫氧胞嘧啶、紫杉烷類（紫杉醇和紫杉萜［泰素帝］)、長春瑞濱等。組合藥物的有效率大于單一藥物，但生存期并沒有延長，且毒性增加。因此，一些腫瘤醫(yī)師傾向連續(xù)使用單一藥物。 | |
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For tumors with amplification of HER2/neu, the humanized monoclonal antibody trastuzumab is effective in treating and controlling visceral metastatic sites. It is used alone or with hormone therapy or chemotherapy. |
對HER2/neu放大腫瘤，人體單克隆抗體曲妥單抗在治療和控制內(nèi)臟轉(zhuǎn)移時有效，它既可單獨使用，也可與激素治療或化療合用。 | |
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About 10% of patients with bone metastases eventually develop hypercalcemia, which can be treated with IV bisphosphonates (eg, pamidronate). |
10%的骨轉(zhuǎn)移病人最終會患高鈣血癥，它可以用二膦酸鹽靜脈治療（如氨羥二磷酸二鈉)。 |
