Naughton Michael J, Ellis Matthew
Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO 63110, USA.
BMC Cancer. 2007 May 30;7:93. doi: 10.1186/1471-2407-7-93.
Pregnancy is infrequently complicated by the diagnosis of a concurrent breast cancer. This presents a particularly complicated clinical problem. The treatment of breast cancer in young women involves a number of difficult decisions regarding therapy. These decisions become even more complex when the concerns of the safety of an unborn child are added to the equation. For breast cancers diagnosed late in the third trimester, it is relatively straight forward to delay therapy until after delivery. For women diagnosed earlier in pregnancy, there are legitimate concerns that delays in therapy may adversely affect outcomes. While there are no randomized trials addressing the optimal treatment of women in this situation, there are case reports, case series, and cohort experiences that provide some insight. There are recommendations available from an international working group and from the National Comprehensive Cancer Network that address the treatment of women in this situation. There is general consensus that both surgery and chemotherapy are relatively safe after the first trimester of pregnancy. It is generally agreed that therapeutic radiation, if necessary, should be delayed until completion of pregnancy.
妊娠期间并发乳腺癌的情况并不常见。这带来了一个特别复杂的临床问题。年轻女性乳腺癌的治疗涉及许多关于治疗的艰难决策。当未出生胎儿的安全问题也被纳入考虑时,这些决策变得更加复杂。对于在孕晚期诊断出的乳腺癌,推迟治疗直到分娩后相对比较直接。对于在孕期较早阶段被诊断出的女性,人们有合理的担忧,即治疗延迟可能会对治疗结果产生不利影响。虽然没有针对这种情况下女性最佳治疗方法的随机试验,但有病例报告、病例系列和队列研究经验提供了一些见解。有一个国际工作组和美国国立综合癌症网络提供了针对这种情况下女性治疗的建议。普遍的共识是,妊娠前三个月后手术和化疗相对安全。一般认为,如果有必要,治疗性放疗应推迟到妊娠结束后进行。