早期乳腺癌保乳术后综合治疗

doi:10.3760/cma.j.issn.1673-422X.2015.07.016

摘要/Abstract

摘要： 早期乳腺癌保乳术结合放疗与根治术效果相当，并且较根治术有着更少的不良反应和更好的美容效果。由于个体差异及肿瘤的内在复杂性，为获得最优疗效，制定结合放疗、化疗、内分泌及靶向治疗的个体化综合治疗方案是早期乳癌保乳术后治疗的必然趋势。

关键词: 乳腺肿瘤, 综合疗法, 放射疗法, 药物疗法

Abstract: For the patients with early breast cancer, the effects of breastconserving surgery combined with radiotherapy and radical resection are equal, and the former shows less adverse reactions and better aesthetic outcome. Because of individual differences and the inherent complexity of tumor, to obtain optimal effects, it is an inevitable trend of making an individual comprehensive therapy, which is a combination of radiotherapy, chemotherapy, endocrine therapy and targeted therapy.

Key words: Breast neoplasms, Combined modality therapy, Radiotherapy, Drug Therapy

董亚勤，杨林. 早期乳腺癌保乳术后综合治疗[J]. 国际肿瘤学杂志, 2015, 42(7): 535-538.

Dong Yaqin, Yang Lin. Comprehensive therapy of early breast cancer after breast-conserving surgery[J]. Journal of International Oncology, 2015, 42(7): 535-538.

参考文献

［1］ Keruakous AR, Sadek BT, Shenouda MN, et al. The impact of isolated tumor cells on locoregional recurrence in breast cancer patients treated with breastconserving treatment or mastectomy without postmastectomy radiation therapy［J］. Breast Cancer Res Treat, 2014, 146(2): 365-370. ［2］ Bartelink H, Maingon P, Poortmans P, et al. Wholebreast irradiation with or without a boost for patients treated with breastconserving surgery for early breast cancer: 20year followup of a randomised phase 3 trial［J］. Lancet Oncol, 2015, 16(1): 47-56. ［3］ START Trialists′ Group, Bentzen SM, Agrawal RK, et al. The UK standardisation of breast radiotherapy (START) trial B of radiotherapy hypofractionation for treatment of early breast cancer: a randomised trial［J］. Lancet, 2008, 371(9618): 1098-1107. ［4］ START Trialists′ Group, Bentzen SM, Agrawal RK, et al. The UK standardisation of breast radiotherapy (START) trial A of radiotherapy hypofractionation for treatment of early breast cancer: a randomised trial［J］. Lancet Oncol, 2008, 9(4): 331-341. ［5］ Cante D, Franco P, Sciacero P, et al. Hypofractionation and concomitant boost to deliver adjuvant wholebreast radiation in ductal carcinoma in situ (DCIS): a subgroup analysis of a prospective case series［J］. Med Oncol, 2014, 31(2): 838. ［6］郝福荣, 吕春燕, 刘杰, 等. 乳腺癌保留乳房术后大分割调强放疗初步临床观察［J］. 中华肿瘤防治杂志, 2013, 20(24): 1912-1916. ［7］邓垒, 惠周光, 王淑莲, 等. 早期乳腺癌保乳术后大分割三维放疗Ⅱ期临床观察［J］. 中华放射肿瘤学杂志, 2013, 22(1): 1-4. ［8］张秋宁, 王强, 冶秀鹏, 等. 早期乳腺癌保乳术后加速部分乳腺放疗的Meta分析［J］. 肿瘤学杂志, 2011, 17(7): 524-529. ［9］ Polgár C, Major T, Fodor J, et al. Highdoserate brachytherapy alone versus whole breast radiotherapy with or without tumor bed boost after breastconserving surgery: sevenyear results of a comparative study［J］. Int J Radiat Oncol Biol Phys, 2004, 60(4): 1173-1181. ［10］ Shah C, Badiyan S, Ben Wilkinson J, et al. Treatment efficacy with accelerated partial breast irradiation (APBI): final analysis of the American society of breast surgeons mammosite() breast brachytherapy registry trial［J］. Ann Surg Oncol, 2013, 20(10): 3279-3285. ［11］ Colleoni M, Cole BF, Viale G, et al. Classical cyclophosphamide, methotrexate, and fluorouracil chemotherapy is more effective in triplenegative, nodenegative breast cancer: results from two randomized trials of adjuvant chemoendocrine therapy for nodenegative breast cancer［J］. J Clin Oncol, 2010, 28(18): 2966-2973. ［12］ Arcangeli G, Pinnarò P, Rambone R, et al. A phase Ⅲ randomized study on the sequencing of radiotherapy and chemotherapy in the conservative management of earlystage breast cancer［J］. Int J Radiat Oncol Biol Phys, 2006, 64(1): 161-167. ［13］ Kim HJ, Kim JS, Chie EK, et al. The sequencing of chemotherapy and radiotherapy in breast cancer patients after mastectomy［J］. Tumori, 2010, 96(1): 28-33. ［14］ Rouёssé J, de la Lande B, BertheaultCvitkovic F, et al. A phase Ⅲ randomized trial comparing adjuvant concomitant chemoradiotherapy versus standard adjuvant chemotherapy followed by radiotherapy in operable nodepositive breast cancer: final results［J］. Int J Radiat Oncol Biol Phys, 2006, 64(4): 1072-1080. ［15］ Hickey BE, Francis D, Lehman MH. Sequencing of chemotherapy and radiation therapy for early breast cancer［J］. Cochrane Database Syst Rev, 2006, 4: CD005212. ［16］ Fisher B, Bryant J, Dignam JJ, et al. Tamoxifen, radiation therapy, or both for prevention of ipsilateral breast tumor recurrence after lumpectomy in women with invasive breast cancers of one centimeter or less［J］. J Clin Oncol, 2002, 20(20): 4141-4149. ［17］ Kim R, Tanabe K, Emi M, et al. Rationale for sequential tamoxifen and anticancer drugs in adjuvant setting for patients with node and receptorpositive breast cancer［J］. Int J Oncol, 2005, 26(4): 1025-1031. ［18］ Pierce LJ, Hutchins LF, Green SR, et al. Sequencing of tamoxifen and radiotherapy after breastconserving surgery in earlystage breast cancer［J］. J Clin Oncol, 2005, 23(1): 24-29. ［19］ Wang, XC, Huang XB, Zhang WD, et al. Sequential study of radiotherapy and hormonal therapy in breast cancer patients undergoing mastectomy or conservative surgery［J］. Zhonghua Yi Xue Za Zhi, 2009, 89(28): 1964-1969. ［20］ Balduzzi A, Leonardi MC, Cardillo A, et al. Timing of adjuvant systemic therapy and radiotherapy after breastconserving surgery and mastectomy［J］. Cancer Treat Rev, 2010, 36(6): 443-450. ［21］ Sorlie T, Tibshirani R, Parker J, et al. Repeated observation of breast tumor subtypes in independent gene expression data sets［J］. Proc Natl Acad Sci USA, 2003, 100(14): 8418-8423. ［22］ Rakha EA, ElSayed ME, Green AR, et al. Prognostic markers in triplenegative breast cancer［J］. Cancer, 2007, 109(1): 25-32. ［23］ Rouzier R, Perou CM, Symmans WF, et al. Breast cancer molecular subtypes respond differently to preoperative chemotherapy［J］. Clin Cancer Res, 2005, 11(16): 5678-5685. ［24］ Swain SM, Baselga J, Kim SB, et al. Pertuzumab, trastuzumab, and docetaxel in HER2positive metastatic breast cancer［J］. N Engl J Med, 2015, 372(8): 724-734. ［25］ Finn RS, Dering J, Ginther C, et al. Dasatinib, an orally active small molecule inhibitor of both the src and abl kinases, selectively inhibits growth of basaltype/"triplenegative" breast cancer cell lines growing in vitro［J］. Breast Cancer Res Treat, 2007, 105(3): 319-326. ［26］ Cameron D, Brown J, Dent R, et al. Adjuvant bevacizumabcontaining therapy in triplenegative breast cancer (BEATRICE): primary results of a randomised, phase 3 trial［J］. Lancet Oncol, 2013, 14(10): 933-942.

[1]	王盈, 刘楠, 郭兵. 抗体药物偶联物在转移性乳腺癌治疗中的研究进展[J]. 国际肿瘤学杂志, 2024, 51(6): 364-369.
[2]	高凡, 王萍, 杜超, 褚衍六. 肠道菌群与结直肠癌非手术治疗的相关研究进展[J]. 国际肿瘤学杂志, 2024, 51(6): 376-381.
[3]	萨蔷, 徐航程, 王佳玉. 乳腺癌免疫治疗研究进展[J]. 国际肿瘤学杂志, 2024, 51(4): 227-234.
[4]	杨智, 陆以乔, 顾花艳, 丁佳玲, 郭贵龙. 肿瘤微环境介导乳腺癌靶向治疗耐药的研究进展[J]. 国际肿瘤学杂志, 2024, 51(4): 235-238.
[5]	李书月, 马辰莺, 周菊英, 徐晓婷, 秦颂兵. 寡转移非小细胞肺癌的放疗进展[J]. 国际肿瘤学杂志, 2024, 51(3): 170-174.
[6]	李济时, 陆钊群, 刘俊茹, 吕建勋, 陈霜, 沈琳, 徐志渊, 吴平安. 新辅助放疗联合部分喉切除术治疗喉滑膜肉瘤1例并文献复习[J]. 国际肿瘤学杂志, 2024, 51(2): 123-125.
[7]	陈波光, 王苏贵, 张永杰. 血清胆碱酯酶与炎症标志物在ⅠA~ⅢA期乳腺癌预后中的作用[J]. 国际肿瘤学杂志, 2024, 51(2): 73-82.
[8]	金旭东, 陈忠坚, 毛伟敏. MTAP基因在恶性间皮瘤中的研究进展[J]. 国际肿瘤学杂志, 2024, 51(2): 99-104.
[9]	中国医师协会放射肿瘤治疗医师分会, 中华医学会放射肿瘤治疗学分会, 中国抗癌协会肿瘤放射治疗专业委员会. 中国食管癌放射治疗指南（2023年版）[J]. 国际肿瘤学杂志, 2024, 51(1): 1-20.
[10]	高新雨, 李振江, 孙洪福, 韩丹, 赵倩, 刘成新, 黄伟. 基于MR加速器的MR引导放疗在食管癌患者中的临床应用[J]. 国际肿瘤学杂志, 2024, 51(1): 37-42.
[11]	顾花艳, 朱腾, 郭贵龙. 乳房微生物群与乳腺癌：现状与未来[J]. 国际肿瘤学杂志, 2024, 51(1): 55-58.
[12]	王景, 许文婷. 中性粒细胞与淋巴细胞比值、癌胚抗原联合凝血指标对直径≤1.0 cm的良恶性乳腺结节鉴别诊断价值研究[J]. 国际肿瘤学杂志, 2023, 50(9): 520-526.
[13]	冯诚天, 黄芙蓉, 曹世玉, 王健宇, 南丁阿比雅思, 姜永冬, 朱娟英. HER2阳性乳腺癌患者HER2表达水平与影像学特征的关系[J]. 国际肿瘤学杂志, 2023, 50(9): 527-531.
[14]	崔腾璐, 吕璐, 孙鹏飞. 放疗联合免疫治疗在头颈部鳞状细胞癌治疗中的应用[J]. 国际肿瘤学杂志, 2023, 50(9): 548-552.
[15]	冯东旭, 吴炜, 高平发, 王军, 施丽娟, 陈大伟, 李文兵, 张美峰. miR-451通过调控Rho/ROCK1信号通路对乳腺癌细胞糖酵解及凋亡的影响[J]. 国际肿瘤学杂志, 2023, 50(8): 449-456.